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 Leukocyte Reduction of Allogeneic Transfusion Products
  Leukocyte Reduction of Allogeneic Transfusion Products

Postoperative Infections
Sternal wound infection has been identified as the most costly complication of open-heart surgery.1

Costly Complications of Open-Heart Surgery


adapted from Taylor et al1

Kluytmans et al2 found that infected cardiac patients had a 2½-fold increase in the length of stay in the hospital (LOS). Mediastinitis was the most important complication, prolonging LOS beyond 50 days.

Infection Prolongs Hospital Stay


   adapted from Kluytmans et al2


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Role of Blood Transfusion
Ottino et al3 found patients who developed mediastinitis had longer procedures, protracted bypass times and increased LOS in the ICU. They also received a greater number of blood transfusions than the non-infected patients.3 The immunosuppressive effect of blood product transfusion is well known4 and immunosuppression may predispose patients to mediastinitis.

Factors Related to Major Sternal Wound Infections


adapted from Ottino et al3

Murphy et al5 observed that patients who acquired infections not only use more hospital resources, adding to the cost of health care, but they also receive a greater amount of transfusion products than non-infected patients.

Patients Acquiring Infections Also Received More Transfusions


   adapted from Murphy et al5

The authors concluded: "Only red cell dose was a significant predictor of all 4 measures of morbidity; infection, days of hospital stay, days of antibiotic and days of fever."5

Infected Patients Require More Resources


   adapted from Murphy et al5


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Mechanism of Immunosuppression
A recent study of spinal surgery patients by Triulzi et al6 revealed, contrary to popular belief, exposure to just a single unit of transfused blood appears to be enough of an immunosuppressive stimulus to significantly increase infection rates.

Dose-Response Relationship Between Allogeneic Transfusion and Infection


   adapted from Triulzi et al6

These infections appeared related to the transfusion of allogeneic blood as opposed to autologous blood.

Infection Rates Rise with Allogeneic Transfusions


 adapted from Triulzi et al6


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Role of Leukocytes
The high rate of infection seen among those patients transfused with allogeneic blood was corroborated by Jensen et al7 in a study of colorectal surgery patients. In addition, their data support the view that the immunosuppressive effect of transfusion is mediated by the white cells because when leukoreduced whole blood products were transfused, infection rates dropped from 23% down to the rates seen in non-transfused patients.

High Infection Rates are Lowered when Leukoreduced Blood is Used


 adapted from Jensen et al7


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High Efficiency Leukocyte Reduction Through Filtration

High efficiency leukocyte reducing filters can provide red cells, platelet and plasma transfusion products with consistent residual leukocyte counts significantly below the guidelines recommended for leukoreduced blood products established by the American Association of Blood Banks8 as well as the more rigorous French standards which recommend that residual white cell counts be below 1 million cells per transfused unit.9


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Summary of Evidence
  • Allogeneic blood transfusion products contain leukocytes.
  • These leukocytes are immunosuppressive and may predispose patients to infection.
  • Leukocyte reduction filters may prevent costly infectious complications.

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Pall Summary
  • Infectious complications appear related to leukocytes contaminating transfusion products.
  • Protect your patients with blood products leukocyte reduced by Pall High Efficiency Filtration.

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    References
    1. Taylor GJ, Mikell FL, Moses HW, et al: Determinants of hospital charges for coronary artery bypass surgery: the economic consequences of postoperative complications. Am J Cardiol 1990; 65:309-313.
    2. Kluytmans JAJW, Mouton JW, Maat APWM, et al: Surveillance of postoperative infections in thoracic surgery. J Hosp Infection 1994; 27:139-147.
    3. Ottino G, De Paulis R, Pansini S, et al: Major sternal wound infection after open-heart surgery: a multivariate analysis of risk factors in 2,579 consecutive operative procedures. Ann Thorac Surg 1994; 44:173-179.
    4. Hart S, Roe JA: Leucocyte depleting filters and cardiothoracic surgery. Perfusion 1993; 8:477-482.
    5. Murphy PJ, Connery C, Hicks GL, Blumberg N: Homologous blood transfusion as a risk factor for postoperative infection after coronary artery bypass graft operations. J Thorac Cardiovasc Surg 1992; 104:1092-1099.
    6. Triulzi DJ, Vanek K, Ryan DH, and Blumberg N: A clinical and immunologic study of blood transfusion and postoperative bacterial infection in spinal surgery. Transfusion 1992; 32:517-524.
    7. Jensen LS, Andersen AJ, Christiansen PM, Hokland P, Juhl CO, Madsen G, Mortensen J, Moller-Nielsen C, Hanberg-Sorensen F, Hokland M: Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery. Brit J Surg 1992; 79:513-516.
    8. Standards for Blood Banks and Transfusion Services, 16th Edition published by the American Association of Blood Banks Standards, 1994.
    9. Journal Officiel de la Republique Francaise, New French leukocyte depletion standard, published May 8, 1994.

    For more information...


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