Prevention of HLA immunization with leukocyte-poor packed red cells and platelet concentrates obtained by filtration

Abstract

HLA immunization is a common complication of transfusion therapy in 30% to 60% of oncohematologic patients. Evidence shows that leukocytes present in cellular blood products are the main component involved in the occurrence of HLA immunization, and several studies showed that leukocyte-poor blood products are less able to induce it. However, leukocyte-poor platelet concentrates obtained by conventional techniques, ie, centrifugation, frequently have a high level of remaining leukocytes. Cotton wool filter Imugard IG 500 can be used to obtain leukocyte-poor cellular blood products. The technique is easy to perform, even in an emergency, and can be used with either packed RBCs or platelet concentrates. Means of 97%, 92%, and 76% elimination of leukocytes are obtained for packed RBCs, pooled standard platelet concentrates, and single-donor platelet concentrates, respectively. Patients were randomized to receive either standard (control group) or filtered (leukocyte-poor group) blood products. Of 112 randomized patients, 69 were evaluable, 35 in the control group and 34 in the leukocyte-poor group. Both groups are comparable according to age, diagnosis, sex ratio, previous transfusions, and pregnancies. There is a significant difference in regard to the HLA immunization rate (31.4% in the control v 11.7% in the leukocyte-poor group, P less than .05) and frequency of refractoriness to platelet transfusions (46.6% v 11.7%, P less than .05). We conclude that this filtration technique can be an efficient means to reduce the HLA immunization rate in polytransfused oncohematologic patients.

Risk of variant Creutzfeldt–Jakob disease in a simulated cohort of Canadian blood donors

“…Blood services have, thus, implemented measures to mitigate the risk of transfusion transmission of vCJD. In the late 1990s and early 2000s, many resource-rich countries adopted universal leukodepletion [7,8] to reduce the risk of vCJD [9][10][11] and other immune and infectious complications resulting from blood transfusion [12,13].…”

“…Blood services have, thus, implemented measures to mitigate the risk of transfusion transmission of vCJD. In the late 1990s and early 2000s, many resource‐rich countries adopted universal leukodepletion [7, 8] to reduce the risk of vCJD [9–11] and other immune and infectious complications resulting from blood transfusion [12, 13]. Given the unclear performance of available blood screening tests and potential logistical problems, several jurisdictions have also implemented donor deferral criteria based on time spent in high‐risk countries, such as the UK, France and Ireland.…”