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: 14.43). 03/1998; 97(6):562-8. DOI: 10.1161/01.CIR.97.6.562
Source: PubMed


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.

Download full-text


Available from: Leo M G van de Watering
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Preterm infants are frequently transfused with red blood cells based on standardized guidelines or clinical concerns that anemia taxes infants' physiological compensatory mechanisms and thereby threatens their health and well-being. The impact of various transfusion guidelines on long-term neurocognitive outcome is not known. The purpose of this study is to evaluate long-term neurocognitive outcome on children born prematurely and treated at birth with different transfusion guidelines. Neurocognitive outcomes were examined at school age for 56 preterm infants randomly assigned to a liberal (n = 33) or restrictive (n = 23) transfusion strategy. Tests of intelligence, achievement, language, visual-spatial/motor, and memory skills were administered. Between-group differences were assessed. Those in the liberal transfusion group performed more poorly than those in the restrictive group on measures of associative verbal fluency, visual memory, and reading. Findings highlight possible long-term neurodevelopmental consequences of maintaining higher hematocrit levels.
    Full-text · Article · Feb 2011 · Child Neuropsychology
    • "There is a risk of exaggerated systemic inflammatory response to use of RPB containing all the systemic inflammatory mediators and increased leukocyte counts, but the present study do not show any evidence of systemic response to use of RPB as evidenced by pyrexia or pericardial effusion. The beneficial effects of leukocyte free blood transfusion are well-documented.[2122] A recent study from Netherlands compared transfusion of leukocyte freed RPB from nonfiltered RPB; although the sample size was small, the study concluded that circulating leucocytes were significantly diminished with the filtered group and could reduce the postoperative inflammatory response in patients undergoing cardiac surgery.[23] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Homologous blood transfusion after open heart surgery puts a tremendous load on the blood banks. This prospective randomized study evaluates the efficacy of infusing back residual cardiopulmonary bypass (CPB) circuit i.e., pump blood as a means to reduce homologous transfusion after coronary artery bypass surgery (CABG) and whether its use increases postoperative drainage. Sixty-seven consecutive patients who underwent elective CABGs under CPB were randomized into 2 groups: (1) cases where residual pump blood was used and (2) controls where residual pump blood was not used. Patients were monitored for hourly drainage on the day of surgery and the 1(st) postoperative day and the requirements of homologous blood and its products. Data were matched regarding change in Hemoglobin, Packed Cell Volume and coagulation parameters till 1st postoperative day. All cases were followed up for three years. There was a marginal reduction in bleeding pattern in the early postoperative period in the cases compared to controls. The requirement of homologous blood and its products were also reduced in the cases. The use of CPB circuit blood is safe in the immediate postoperative period. The requirement of homologous blood transfusion can come down if strict transfusion criteria are maintained.
    No preview · Article · Jul 2008 · Asian Journal of Transfusion Science
  • Source
    • "Elsewhere, work has focused on leukocyte filtration using a separate veno-venous extracorporeal circuit, both European Journal of Cardio-thoracic Surgery 31 (2007) 665—676 intra-operatively [13], and post-operatively [14], and on filtering the blood used for priming the circuit [15] or all the transfused blood received during a hospital admission [16]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: It is known that cardiopulmonary bypass causes an inflammatory reaction with an associated morbidity and mortality. Several anti-inflammatory strategies have been implemented to reduce this response, including leukocyte removal from the circulation using specialised filters. The aim of this study is to systematically review the available evidence on leukocyte filtration in cardiac surgery, focusing on its effect on systemic inflammation and whether this has influenced clinical outcomes. Five electronic databases were systematically searched for studies reporting the effect of leukocyte filtration at any point within the cardiopulmonary bypass circuit in humans. Reference lists of all identified studies were checked for any missing publications. Two authors independently extracted the data from the included studies. Whilst systemic leukodepleting filters do not appear to consistently lower leukocyte counts, they may preferentially remove activated leukocytes. Small improvements in early post-operative lung function in patients receiving systemic leukodepletion have been reported, but this does not lead to reduced hospital stay or decreased mortality. There is substantial evidence that cardioplegic leukocyte filtration attenuates the reperfusion injury at a cellular level, but this has not been translated into clinical improvements. Finally, whilst various strategies involving multiple leukocyte filters, or the incorporation of pharmacological agents into leukocyte-depleting protocols have been evaluated, the current available results are not conclusive. Our study suggests that there is not enough high quality or consistent evidence to draw guidelines regarding the use of leukocyte-depleting filters within routine cardiac surgical practice.
    Full-text · Article · May 2007 · European Journal of Cardio-Thoracic Surgery
Show more