The Effects of Leukoreduced Blood Transfusion on Infection Risk Following Injury

Abstract

Allogeneic blood transfusions in surgical patients have been associated with an increased risk of infectious complications and organ dysfunction. Residual leukocytes contaminating units of packed red blood cells have been incriminated through the induction of anergy and/or a potentiated inflammatory response, leading to the possibility that leukoreduced red blood cell transfusion might mitigate these effects. We set out to evaluate the effect of leukoreduced red cell transfusion on the risk of infections complications in patients requiring transfusion following injury. We conducted a single-center, double-blinded randomized controlled trial of leukoreduced versus standard, nonleukoreduced red blood cell transfusions in injured patients receiving transfusion within 24 hrs of injury. The primary endpoint was infectious complications within 28 days of randomization. Secondary end points were multiple organ failure, length of stay, febrile episodes, and mortality. Two hundred sixty eight subjects were eligible for analysis. Rates of infectious complications were similar in subjects receiving leukoreduced transfusions (30%) or standard transfusions (36%) ([RR], 0.84 [0.55-1.3]) and there was no statistically significant effect of leukoreduced blood transfusion on mortality [RR, 1.20 (0.74-1.9)], febrile episodes [RR, 1.01 (0.89-1.2)], or organ dysfunction scores (5.9 vs. 6.6; P=0.29). Thus, pre-storage leukoreduction of allogeneic red blood cells had a small, but non-significant effect on the rate of infectious complication in this high-risk population requiring transfusion. There was no effect on the rates of febrile episodes, mortality, length of stay, or severity of organ dysfunction.

Early massive transfusion in trauma patients: Canadian single-centre retrospective cohort study

“…However, despite considerable theoretical advantages, clinical benefits of leukoreduction have been inconsistent in observational studies [39][40][41] and randomized trials. [42][43][44] In our study, later year of hospital admission was not associated with improved outcomes. However, our dataset is underpowered to examine the effect of leukoreduction specifically, since relatively few patients (*20%) were included in the post-leukoreduction period.…”

Anemia in Critical Illness

“…However, a subsequent meta-analysis of before-and-after studies did not show any effect of leukoreduction on postoperative infection or mortality, after adjusting for confounding factors (73). In trauma patients, before-and-after cohort studies have shown decreased rates of nosocomial infection and ARDS (74,75), but randomized clinical trials have shown no effect of leukoreduction on these outcomes (76,77).…”

Allogeneic leukocytes in cardiac surgery: Good or bad?

“…These studies included singleand multicenter designs, clinical diagnosis, methods for documenting and reporting infections, and the proportion of transfused patients (range: 14%-95%). Among them, 5 included patients undergoing colorectal or gastrointestinal surgery [40][41][42][43][44], 1 was performed with patients undergoing aortic aneurysm repair or resection of gastrointestinal malignancy [45], and 1 included trauma patients [46]. The postoperative infection results in these RCTs, which were conducted with different patient populations using different study designs, are inconsistent.…”

“…In total, 13 RCTs on leukodepleted blood transfusions in different clinical settings evaluated postoperative infections as a primary or secondary endpoint [31][32][33][34][35][36][40][41][42][43][44][45][46]. These studies included singleand multicenter designs, clinical diagnosis, methods for documenting and reporting infections, and the proportion of transfused patients (range: 14%-95%).…”