An association between decreased cardiopulmonary complications (transfusion‐related acute lung injury and transfusion‐associated circulatory overload) and implementation of universal leukoreduction of blood transfusions
- 3 December 2010
- journal article
- research article
- Published by Wiley in Transfusion
- Vol. 50 (12), 2738-2744
- https://doi.org/10.1111/j.1537-2995.2010.02748.x
Abstract
BACKGROUND: Cardiopulmonary adverse events after transfusion include transfusion‐related acute lung injury (TRALI) and transfusion‐associated circulatory overload (TACO), which are potentially lethal and incompletely understood. STUDY DESIGN AND METHODS: To determine whether the incidence of TRALI and TACO was affected by leukoreduction we conducted a retrospective, before‐and‐after study of acute transfusion reactions for the 7 years before and after introduction of universal leukoreduction in 2000, involving 778,559 blood components. RESULTS: Substantial decreases occurred in the rates of TRALI (−83%; from 2.8 cases per 100,000 components before to 0.48 after universal leukoreduction; p = 0.01), TACO (−49%; 7.4 to 3.8 cases per 100,000; p = 0.03), and febrile reactions (−35%; 11.4 to 7.4 cases per 10,000; p < 0.0001). The incidence of allergic reactions remained unchanged (7.0 per 100,000 before and after universal leukoreduction). These outcomes were primarily attributable to decreased TRALI and/or TACO associated with red blood cell (RBC) and platelet (PLT) transfusions (−64%) with notably smaller decreases associated with fresh‐frozen plasma or cryoprecipitate transfusions (−29%). The incidence of TRALI and/or TACO after 28,120 washed RBC and 69,325 washed transfusions was zero. CONCLUSION: These data suggest novel hypotheses for further testing in animal models, in prospective clinical trials, and via the new US hemovigilance system: 1) Is TACO or TRALI mitigated by leukoreduction? 2) Is the mechanism of TACO more complex than excessive blood volume? and 3) Does washing mitigate TRALI and TACO due to PLT and RBC transfusions?Keywords
This publication has 17 references indexed in Scilit:
- Transfusion‐related acute lung injury (TRALI): a clinical review with emphasis on the critically illBritish Journal of Haematology, 2009
- The effect of previous pregnancy and transfusion on HLA alloimmunization in blood donors: implications for a transfusion‐related acute lung injury risk reduction strategyTransfusion, 2009
- Ten years of hemovigilance reports of transfusion‐related acute lung injury in the United Kingdom and the impact of preferential use of male donor plasmaTransfusion, 2009
- TRALI risk reduction: Donor and component management strategiesJournal of Clinical Apheresis, 2009
- Effects of leukoreduced blood on acute lung injury after trauma: A randomized controlled trial*Critical Care Medicine, 2008
- Evidence for activation of immune system in heart failure: is there a role for anti-inflammatory therapy?Current Opinion in Cardiology, 2008
- Soluble CD40 ligand accumulates in stored blood components, primes neutrophils through CD40, and is a potential cofactor in the development of transfusion-related acute lung injuryBlood, 2006
- Pulmonary consequences of transfusion: TRALI and TACOTransfusion and Apheresis Science, 2006
- Pulmonary edema after transfusion: How to differentiate transfusion-associated circulatory overload from transfusion-related acute lung injuryCritical Care Medicine, 2006
- Platelet storage lesion: An update on the impact of various leukoreduction processes on the biological response modifiersTransfusion and Apheresis Science, 2006