The Clinical Importance of Leukocyte Depletion in Regular Erythrocyte Transfusions

Abstract

Antilymphocyte, antigranulocyte and antiplatelet alloantibodies, T lymphocyte subsets, expression of HLA-DR antigens on T lymphocytes and NK cell function were determined in 11 homozygous β-thalassemic children multitransfused ab initio with Erypur-filtered leukocyte-free red cell units (group A) and in 13 similar children multitransfused with standard packed red cell units (group B). No antibodies were found in group A patients, whereas 69% of group B patients were immunized. The two groups did not differ significantly with regard to the other test results. Considered together, thalassemia patients showed a percentage of T4+ cells and a NK cell function that were significantly lower than those found in a reference group of 16 healthy male blood donors. Thalassemics moreover showed a higher than normal percentage of T3+, T4+ and T8+ cells expressing HLA-DR antigens. The results indicate that leukocyte-free red cells should be the treatment of choice for prospective recipients of multiple transfusions, since they are capable of preventing (or delaying) the production of alloantibodies against leukocytes and platelets. From the data of the present study, it does not seem that the transfusion of leukocyte-free red cells is capable of preventing the abnormalities of some immunological tests that occur in some multitransfused patients. Further investigations, however, are needed to draw conclusions on this problem.

A New Cellulose Acetate Filter to Remove Leukocytes from Buffy-Coat-Poor Red Cell Concentrates

“…Our results indicate that the new Cellselect-A filter equals the original Cellselect filter in removing more than 99% of the leukocytes from buffy-coat-poor RCC, in accordance with the findings of others [2][3][4][5][6], who have investigated in the Cellselect filter. Dependent on the hematocrit of the RCC, the filtration time is only 10 min with the Cellselect-A filter.…”

“…We compared the efficiency of both filters. Removal of leukocytes from red cell concentrates (RCC) is the method of choice to avoid or delay immu nization against leukocyte and platelet antigens in multi transfused patients, i.e., patients with various hematolog ical diseases, patients on hemodialysis, and prospective candidates for multiple platelet transfusions or bone mar row or kidney transplants [1,2], One of the most simple and reliable methods to remove more than 95% of the leukocytes from whole blood or RCC is filtration of the red cell suspension through a sterile column prepacked with cellulose acetate (Cellselect, NPBI, The Netherlands; identical with Erypur, Organon Teknika, The Netherlands) or cotton wool (Imugard, Terumo, Japan) [3][4][5][6].…”

Storage of Leukocyte-Poor Red Cell Concentrates: Filtration in a Closed System Using a Sterile Connection Device

“…It has been shown in animal studies that these fragments are still HLA-immunogenic Transfusion of leukocyte-poor red cell concentrates (LP-RCC) has greatly diminished nonhemolytic transfusion re actions and HLA-immunization in repeatedly transfused patients [1][2][3][4][5].…”

Incidence and specificity of HLA antibodies in multitransfused patients with acquired aplastic anemia

“…Exceptions to this rule are the “plasma protein fraction” and albumin 1 . WBCs are implicated as the prime source of sensitization because nonleukofiltered blood is more immunogenic than leukofiltered blood (in which the total number of WBCs is reduced to below 1‐5 × 10 6 per unit) 2‐10 …”