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Inline-filtration.

Ralf Karger1, Volker Kretschmer

  • 1Institut für Transfusionsmedizin und Hämostaseologie, Klinikum der Philipps Universität Marburg, Germany.

Transfusion and Apheresis Science : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis
|September 28, 2002
PubMed
Summary

Routine leukocyte depletion (LD) of blood products lacks sufficient evidence for widespread use. While LD offers some benefits, its high cost and potential to worsen blood shortages outweigh its proven advantages for most patients.

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Area of Science:

  • Transfusion Medicine
  • Hematology
  • Infectious Disease Prevention

Background:

  • Leukocyte-depletion (LD) of blood products is increasingly implemented in Europe due to concerns about variant Creutzfeldt-Jakob disease (vCJD) transmission.
  • The scientific evidence supporting vCJD transmission via transfusion is scarce, and the benefits of routine LD for all patients remain largely unproven.

Purpose of the Study:

  • To evaluate the scientific evidence supporting the routine use of leukocyte-depletion (LD) in blood product transfusion.
  • To assess the proven benefits and potential risks of LD in various patient populations and transfusion scenarios.

Main Methods:

  • A comprehensive MEDLINE search was conducted to identify studies on the indications for leukocyte depletion.
  • Guidelines and recommendations from national and international health authorities regarding LD were critically reviewed.

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Main Results:

  • Proven benefits of LD include reducing febrile reactions, HLA-immunization, and platelet refractoriness in specific patient groups.
  • LD may reduce transfusion-transmitted CMV disease in immunocompromised patients and prevent a small percentage of transfusion-related acute lung injury.
  • Evidence for LD reducing immunomodulatory effects, septicemia, or preventing vCJD transmission is inconclusive or hypothetical; AIDS patients do not benefit.

Conclusions:

  • Current scientific evidence does not justify the routine implementation of leukocyte depletion.
  • The cost-effectiveness of LD is questionable, potentially diverting resources from more impactful medical services.
  • Routine LD may exacerbate blood supply shortages due to a 5-10% loss of the red cell pool.