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Effectiveness of WBC reduction in neonates: what is the evidence of benefit?
Dean Fergusson1, Paul C Hébert, Keith J Barrington
1Center for Transfusion Research and the Department of Medicine, Ottawa Hospital, University of Ottawa, Ontario, Canada. dafergusson@ottawahospital.on.ca
Insights
White blood cell (WBC) reduction in red blood cells (RBCs) may benefit neonates, but evidence is limited. Further research is needed to confirm the clinical and economic impact of WBC reduction in this population.
Area of Science:
- Neonatal Transfusion Medicine
- Immunology
- Infectious Disease Prevention
Background:
- White blood cells (WBCs) in red blood cells (RBCs) are linked to adverse transfusion effects in recipients.
- WBC reduction in adults reduces HLA alloimmunization, CMV/HTLV infections, and febrile reactions.
- Neonates possess immature immune systems and undergo frequent RBC transfusions, necessitating specific considerations.
Purpose of the Study:
- To systematically review evidence on WBC reduction in neonatal RBC transfusions.
- To determine if WBC reduction decreases CMV transmission, HLA antibody development, or immunomodulation in neonates.
- To analyze the impact on nosocomial infection, mortality, and hospital stay duration.
Main Methods:
- Systematic literature review of studies on WBC reduction.
- Grouping eligible studies by outcome.
- Pooling data where appropriate to determine the overall effect measure.
Main Results:
- Nine studies were identified; six were evaluable.
- Two studies on CMV transmission showed non-significant pooled odds ratio (OR) of 0.19.
- Two studies on HLA antibody development showed non-significant pooled OR of 0.17; two small studies indicated significant changes in lymphocyte subsets.
Conclusions:
- Current evidence suggests potential efficacy of WBC reduction in neonates, but further research is required.
- Lack of convincing data and high cost necessitate evaluations of clinical and economic impact.
- More robust studies are needed to establish definitive benefits of WBC reduction in neonatal transfusions.
Background:
The presence of WBCs in RBCs is thought to be associated with a number of significant adverse effects in recipients. In adults, WBC reduction has been shown to reduce the frequency of HLA alloimmunization, CMV and HTLV infections, and febrile nonhemolytic transfusion reactions. However, neonates are unique, given that they have an immature immune system and are frequently transfused with RBCs. Thus, the aims of this systematic review were to determine whether WBC reduction of RBCs transfused to neonates decreases the transmission of CMV, reduces the ability to develop HLA antibodies, or reduces the risk of immunomodulation. In addition, nosocomial infection, mortality, and duration of stay were identified and analyzed.
Study Design And Methods:
All studies of WBC reduction were identified by a systematic review of the literature. Studies meeting the inclusion criteria were grouped based on study outcome. Where appropriate, studies were pooled to obtain an overall measure of effect.
Results:
Nine eligible studies were identified from the systematic literature search, and six were deemed evaluable. Two studies evaluated WBC reduction and the development of CMV, with different results. The pooled OR was 0.19 (95% Cl, 0.01-3.41), suggesting a clinical but nonsignificant effect. Two studies evaluated WBC reduction and HLA antibody development. As with CMV, the two studies were not congruent in their results. The pooled OR was 0.17 (95% Cl, 0.01-2.43). As for immunomodulation, two small studies presented evidence of a statistically significant change in lymphocyte subsets. No studies were identified with a primary objective of evaluating the impact of WBC reduction on nosocomial infection, mortality, or duration of stay.
Conclusion:
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.
