Beneficial effects of leukocyte depletion of transfused blood on postoperative complications in patients undergoing cardiac surgery: a randomized clinical trial.

Department of Immunohematology and Blood Bank, Leiden University Medical Centre, The Netherlands.
Circulation (Impact Factor: 14.95). 03/1998; 97(6):562-8. DOI: 10.1161/01.CIR.97.6.562
Source: PubMed

ABSTRACT Leukocytes in transfused blood are associated with several posttransfusion immunomodulatory effects. Although leukocytes play an important role in reperfusion injury, the contribution of leukocytes in transfused blood products has not been investigated. To estimate the role and the timing of leukocyte filtration of red cells in cardiac surgery, we performed a randomized study.
Patients scheduled for cardiac surgery were randomly allocated to receive either packed cells without buffy coat (PC, n = 306), fresh-filtered units (FF, n = 305), or stored-filtered units (SF, n = 303) when transfusion was indicated. We evaluated the periods of hospitalization and stay at the intensive care unit, and the occurrences of postoperative complications up to 60 days after surgery. The average hospital stay was 10.7 days, of which 3.2 days were in the intensive care unit, without significant differences between the groups. In the PC trial arm, 23.0% of the patients had infections versus 16.9% and 17.9% of the patients in the leukocyte-depleted trial arms (P=.13). Within 60 days, 45 patients had died, 24 patients in the PC trial arm (7.8%), versus 11 (3.6%) and 10 (3.3%) patients in the FF and SF trial arms, respectively (P=.015).
In cardiac surgery patients, especially when more than three blood transfusions are required, leukocyte depletion by filtration results in a significant reduction of the postoperative mortality that can only partially be explained by the higher incidence of postoperative infections in the PC group.

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Available from: Leo M G van de Watering, Jul 07, 2015
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    • "As with any medical procedure, the benefits and protective factors associated with RBC transfusion must be carefully weighed in light of potential risks. In addition to being costly (Murray & Roberts, 2004), transfusions are associated with a number of well-documented risks associated with blood incompatibility, immunosuppression or immune activation (Bordin, Heddle, & Blajchman, 1994; Jeschke, Chinkes, Finnerty, Przkora, Pereira, & Herndon, 2007; Marik, 2009; van de Watering et al., 1998), and transfusion reactions or infections such as viral hepatitis and cytomegalovirus (Szekely et al., 2009). Studies have also shown that the risks of transfusion complications may be more pronounced for the most critically ill infants and as the amount of blood transfused increases (Jeschke et al., 2007). "
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