Leucocyte‐Depleted Blood in Prevention of Post‐Operative Infections Following Elective Orthopaedic and Cardiac Procedures

Leukocyte Reduction in Blood Component Supply: The Impact of Flow Cytometry in Assessing Residual Leukocytes

“…For cardiac patients, there was no significant difference concerning the postoperative length of stay (7.4 vs. 8.3 days) and the postoperative prescription of antibiotics. In contrast, orthopedic patients profited from the use of leukocyte-depleted RBC units, resulting in a highly significant shortening of hospital stay (11.7 vs. 10.5 days, p = 0.004), whereas the trend of fewer postoperative infections (antibiotic prescription rate 15.0 vs. 11.9%, p = 0.085) did not reach statistical significance [17]. In the last few years, universal leukocyte reduction was mandated by governments of several European nations and Canada, pushed by public perception due to the potential risk of transmission of prion-mediated spongiform encephalopathies (variant of Creutzfeldt-Jakob disease; vCJD).…”

“…In addition, the advocacy of universal leukocyte reduction is supported by further observations such as the supposed immunosuppressive effects of allogeneic leukocytes, resulting in higher rates of postoperative bacterial infections and increased probability of cancer recurrence [14,15]. However, until now the results of randomized studies have remained contradictory and failed to establish the advantages of universal leukocyte reduction [16,17]. Van de Watering et al [15] did not find any statistically significant difference in the incidence of perioperative infections as well as duration of hospitalization and intensive care unit hospitalization when comparing buffy-coat-depleted, pre-and poststorage leukocyte-reduced RBC units.…”

“…The authors concluded that a general beneficial effect of universal leukocyte reduction was not demonstrated. Williamson et al [17] conducted a multicenter cohort study in patients with elective orthopedic and cardiac operations who received RBC units neither leukocyte-depleted nor buffy-coat-depleted or leukocyte-depleted (<5 × 10 6 WBCs/unit) RBC units. For cardiac patients, there was no significant difference concerning the postoperative length of stay (7.4 vs. 8.3 days) and the postoperative prescription of antibiotics.…”

White blood cell‐containing allogeneic blood transfusion, postoperative infection and mortality: a meta‐analysis of observational ‘before‐and‐after’ studies

“…The French study [7] included patients transfused with non‐WBC‐reduced components between January 1995 and March 1998, and subjects transfused with WBC‐reduced components between April 1998 and October 2000. Depending on the participating hospital, the English study [8] included patients transfused with non‐WBC‐reduced components during a 5‐month time‐period in 1999, and subjects transfused with WBC‐reduced components over the same time‐period in 2000. Of the two Canadian studies, Hébert et al .…”

“…Because the stringency of a definition of postoperative infection used in the primary analysis presented by the authors of each report varied greatly (Table 1), three more meta‐analyses were conducted (in addition to the meta‐analysis that integrated the results of each team's [7–10,18] primary analysis). These meta‐analyses integrated the findings of subsets of studies that reported results based on similar definitions of postoperative infection.…”