Effectiveness of WBC reduction in neonates: what is the evidence of benefit?

Fergusson, Dean; Hébert, Paul C.; Barrington, Keith J.; Shapiro, Stanley H.

doi:10.1046/j.1537-2995.2002.00022.x

Cited by 21 publications

(15 citation statements)

References 31 publications

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“…The United States and Japan do not practice universal leukoreduction. 21, 22 The evidence to support leukoreduction is mixed and suggests that leukoreduction has no effect on clinical outcomes in certain patient populations, including trauma patients. 22–25 Furthermore, leukoreduction is expensive.…”

Section: Discussionmentioning

confidence: 99%

“…21, 22 The evidence to support leukoreduction is mixed and suggests that leukoreduction has no effect on clinical outcomes in certain patient populations, including trauma patients. 22–25 Furthermore, leukoreduction is expensive. 26 Because of conflicting data supporting its efficacy concerning patient outcomes and significant difference in cost, further studies are required before leukoreduction will be required worldwide.…”

Section: Discussionmentioning

confidence: 99%

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Resuscitation with washed aged packed red blood cell units decreases the proinflammatory response in mice after hemorrhage

Belizaire

Makley

Campion

et al. 2012

Journal of Trauma and Acute Care Surgery

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BACKGROUND Resuscitation with blood products instead of crystalloid in the treatment of hemorrhagic shock has been associated with improved outcomes in trauma patients requiring massive transfusions and transfusion of fresh products results in reduced morbidity and mortality compared with aged blood. Processes to eliminate harmful components of aged blood are under investigation. We hypothesized that washing blood would reduce levels of proinflammatory mediators in stored units, and resuscitation with washed units would attenuate the proinflammatory response in mice after hemorrhagic shock. METHODS Mice underwent pressure-controlled hemorrhage and resuscitation with fresh packed red blood cells (pRBCs) or 15-day-old washed or unwashed pRBCs. Cytokine concentrations in donor samples and recipient serum were measured. In addition, cytokine concentrations were measured in 15-day-old units that underwent three interval washes versus one poststorage wash. RESULTS Blood stored for 15 days demonstrated increased levels of interleukin lα, keratinocyte chemoattractant, macrophage inflammatory protein 1α, and macrophage inflammatory protein 2 compared with fresh units. Washing 15-day-old pRBCs reduced concentrations of these cytokines. Cytokine levels in stored units that underwent multiple washes versus a single wash were not different. Mice resuscitated with 15-day-old unwashed pRBCs had increased levels of serum cytokines compared with mice resuscitated with fresh and 15-day-old washed pRBCs. CONCLUSION Aged pRBC units have elevated levels of proinflammatory cytokines compared with fresh units, and washing aged units after storage reduces cytokine concentrations. Resuscitation with washed units blunts the proinflammatory response in mice after hemorrhage. Washing aged pRBCs may improve the safety profile of aged units and may result in improved outcomes in subjects after hemorrhagic shock and resuscitation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Resuscitation with washed aged packed red blood cell units decreases the proinflammatory response in mice after hemorrhage

Belizaire

Makley

Campion

et al. 2012

Journal of Trauma and Acute Care Surgery

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“…Sepsis in the ET group may also have been caused by administration of infected blood products. Although the current risk of transmission of infectious diseases is relatively low, it is not completely negligible [5,21]. Furthermore, ET-related washout of leukocytes may also play a role in the higher incidence of sepsis in the ET group, since in double-volume ET, more than 90% of circulating blood is replaced by leukocyte-depleted donor blood [21,22].…”

Section: Discussionmentioning

confidence: 99%

“…Although the current risk of transmission of infectious diseases is relatively low, it is not completely negligible [5,21]. Furthermore, ET-related washout of leukocytes may also play a role in the higher incidence of sepsis in the ET group, since in double-volume ET, more than 90% of circulating blood is replaced by leukocyte-depleted donor blood [21,22]. Finally, limited data on leukocytopenia in neonates with HDFN due to red cell alloimmunization show that the risk of leukocytopenia is increased in severe Rhesus HDFN [23,24].…”

Section: Discussionmentioning

confidence: 99%

Neonatal Morbidity after Exchange Transfusion for Red Cell Alloimmune Hemolytic Disease

Smits-Wintjens

Rath²,

Zwet³

et al. 2012

Neonatology

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Background: Exchange transfusion (ET) is a high-risk procedure. The type and rate of complications in neonatal red cell alloimmune hemolytic disease exclusively are not clear. Objectives: Our aim was to study the type and rate of complications associated with ET in a large series of neonates with hemolytic disease of the fetus and newborn (HDFN) due to red cell alloimmunization. Methods: All neonates with HDFN due to red cell alloimmunization admitted to our center between January 2001 and June 2011 were eligible for this study. We recorded the number and rate of complications during admission in the group of neonates treated with ET (ET group) and not treated with ET (no-ET group). Multivariate logistic regression analysis was performed to measure the independent risk of complications of ET treatment. Results: A total of 347 infants with red cell alloimmune hemolytic disease were included; 39% (134/347) were treated with at least one ET (ET group), and 61% (213/347) did not require ET (no-ET group). Comparison between the ET group and no-ET group showed that ET treatment was independently associated with proven sepsis [8 vs. 1%, respectively; odds ratio (OR) 8.3, 95% confidence interval (CI) 1.7–40.3; p = 0.009], leukocytopenia (88 vs. 23%, respectively; OR 36.0, 95% CI 17.5–73.8; p < 0.001), severe thrombocytopenia (platelet count <50 × 10⁹/l; 63 vs. 8%, respectively; OR 31.4, 95% CI 14.0–70.4; p < 0.001), hypocalcemia (22 vs. 1%, respectively; OR 27.4, 95% CI 5.9–126.8; p < 0.001) and hypernatremia (8 vs. 0%, respectively; p < 0.001). There were no neonatal deaths in the ET group. Conclusion: ET in neonates with HDFN is associated with an increased risk of sepsis, leukocytopenia, thrombocytopenia, hypocalcemia and hypernatremia.

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“…There is debate about the data of Ohto et al, 23 suggesting that gamma irradiation of blood can reduce the chance of post-transfusion CMV infection by interfering with the allograft reaction ability of the donor lymphocytes needed to activate latent CMV in leukocytes. 24,25 Blood transfused to our infants has been gamma irradiated, possibly reducing this mode of acquisition of CMV.…”

Section: Discussionmentioning

confidence: 99%

Perinatal or early-postnatal cytomegalovirus infection in preterm infants under 34 weeks gestation born to CMV-seropositive mothers within a high-seroprevalence population

Mussi-Pinhata

Yamamoto

Rego

et al. 2004

The Journal of Pediatrics

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Effectiveness of WBC reduction in neonates: what is the evidence of benefit?

Abstract: Current evidence suggests that WBC reduction may be effective in neonates; however, further studies are needed. The lack of convincing data and the significant cost of WBC reduction mandate evaluations to determine the clinical and economic impact.

Cited by 21 publications

References 31 publications

Resuscitation with washed aged packed red blood cell units decreases the proinflammatory response in mice after hemorrhage

Resuscitation with washed aged packed red blood cell units decreases the proinflammatory response in mice after hemorrhage

Neonatal Morbidity after Exchange Transfusion for Red Cell Alloimmune Hemolytic Disease

Perinatal or early-postnatal cytomegalovirus infection in preterm infants under 34 weeks gestation born to CMV-seropositive mothers within a high-seroprevalence population

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