Question 29.2

Pass rate: 23%

Highest mark: ?

Leukodepleted blood is being introduced into clinical practice in Australia. What are the perceived benefits of using such blood?

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College Answer

Benefits include : 
1.   Reduction in non haemolytic transfusion reactions
2.   Reduction in CMV transmission risk
3.   Improved chance of finding an organ transplant match if required
4.   Reduction in storage lesion effect
5.   Reduction in graft v host disease risk
6.   Hebert   has   shown   (JAMA   2003)   reduction   in   mortality   after   universial leukodepetion n populations which include cardiac surgical, orthopaedic and trauma.

Discussion

Benefits of leukodepleted blood are discussed in greater detail elsewhere.

In lieu of a detailed summary, I reproduce this table:

Advantages of Leukodepleted Red Cell Transfusion
  • Reduced risk of TRALI
  • Reduced febrile non-hemolytic reactions
  • Reduced storage lesions
  • Reduced incidence of transfusion-associated GVHD
  • Reduced CMV infection risk
  • Reduced risk of transmission of CJD
  • Reduced risk of alloimmunisation to Class I HLA antigens (a major contributor to platelet refractoryness)

As a brief aside, Australian PRBCs are now routinely leukodepleted, whereas back in the day one would run the undepleted PRBCs through a filter at the bedside. Some believe that there is a good reason we spend money on this practice, even though there is no evidence to support the "extended indications" for leukoreduction.

The hard indications for leukoreduced blood products are as follows:

  • People who are likely to receive a massive transfusion
  • People in whom being platelet refractory would be problematic
  • People at risk of febrile reaction (eg. those alloimmunised during pregnancy)
  • People at risk of severe CMV infection (eg. BMT recipients)

There is no evidence that the use of leukodepleted red cells is having any influence on mortality of transufusion recipients, outside of the above indication.

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References

Goodnough, Lawrence T., Jerrold H. Levy, and Michael F. Murphy. "Concepts of blood transfusion in adults." The Lancet 381.9880 (2013): 1845-1854.

Spahn, Donat R., and Lawrence T. Goodnough. "Alternatives to blood transfusion." The Lancet 381.9880 (2013): 1855-1865.

There is also a rescinded document from the NHMRC (2001) which has been used to guide practice:Clinical Practice Guidelines on the Use of Blood Components.

To some extent this document has been superceded by the Australian and New Zealand Society of Blood Transfusion GUIDELINES FOR THE ADMINISTRATION OF BLOOD PRODUCTS.

The Patient Blood Management Guidelines from the National Blood Authority of Australia is another series of documents worth looking at - it contains several important modules which have been reviewed and which act as successors to the 2001 NHMRC guidelines.

Treleaven, Jennie, et al. "Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force." British Journal of Haematology 152.1 (2011): 35-51.

Aoun, Elie, et al. "Transfusion‐associated GVHD: 10 years’ experience at the American University of Beirut—Medical Center." Transfusion 43.12 (2003): 1672-1676.

Heddle, Nancy M., and Morris A. Blajchman. "The leukodepletion of cellular blood products in the prevention of HLA-alloimmunization and refractoriness to allogeneic platelet transfusions [editorial]." Blood 85.3 (1995): 603-606.

Sharma, R. R., and Neelam Marwaha. "Leukoreduced blood components: Advantages and strategies for its implementation in developing countries."Asian journal of transfusion science 4.1 (2010): 3.

Dzik, Walter H. "Leukoreduction of blood components." Current opinion in hematology 9.6 (2002): 521-526.

Corwin, Howard L., and James P. AuBuchon. "Is leukoreduction of blood components for everyone?." JAMA 289.15 (2003): 1993-1995.

Blajchman, M. A. "The clinical benefits of the leukoreduction of blood products."Journal of Trauma-Injury, Infection, and Critical Care 60.6 (2006): S83-S90.

Rosenbaum, Lizabeth, et al. "The reintroduction of nonleukoreduced blood: would patients and clinicians agree?." Transfusion 51.12 (2011): 2739-2743.

Bilgin, Y. M., L. M. van de Watering, and A. Brand. "Clinical effects of leucoreduction of blood transfusions." Neth J Med 69.10 (2011): 441-450.