Leukocyte Reduction Cost-effectively Reduces Post Operative Infection

Over 23 million units of blood components are used to save the lives of millions of Americans each year, making transfusion support a cornerstone in modern medicine. Despite the many benefits of blood transfusion, complications may arise as well. A blood transfusion, in many ways, is like an organ transplant. Factors specific to the donor may cause complications in the recipient such as fever, chills, antibody buildup or suppression of their immune system.

White blood cells (leukocytes) play a critical role in our own defense against infection. However leukocytes, which are present in all donated blood components, are unintentionally transfused along with the intended product and serve little purpose to the transfusion recipient. In fact, these leukocytes have been shown to be immunosuppressive¹ and can predispose patients to an increased risk of infection^2,3 and mortality⁴. Fortunately, leukocyte reduction by filtration prevents these complications^2,3 and, in turn, reduces the cost of care⁵.

Removing Leukocytes from Donor Blood Reduces Infection

Studies have shown that the rate of post-operative infection in patients who receive an allogeneic (donor) blood transfusion is greater than the rate of infection for those receiving an autologous (self donated) transfusion (see Figure 1). Figure 1: Infection Rates Rise with Allogeneic Transfusions

The high rate of infection seen among those patients transfused with allogeneic blood was corroborated by Jensen et al ³ in a recent study of elective colorectal surgery patients. The data from their study demonstrates that the immunosuppressive effect of transfusion is mediated by passenger leukocytes and that patients who receive leukocyte reduced blood have significantly reduced rates of:

Postoperative infection,
Re-operation and
Pneumonia.

They conclude their study by recommending the "…routine use of leukocyte-depleted blood in all patients undergoing colorectal surgery."

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Studies Indicate that Leukocyte Reduction Improves Patient Outcome and Reduces Costs

Infectious complications are expensive to treat and therefore provide an important challenge to hospitals under increasing pressure to control their costs. Kluytmans et al ⁶ characterized the magnitude of this morbidity, showing that transfusion-related infections can increase the length of hospital stay two and one half times. Murphy and colleagues⁷ observed that surgical patients who incurred postoperative infections required more allogeneic red cell transfusions, had longer hospital stays, more days of antibiotic treatment and more days of fever than non-infected patients (see Figure 2).Figure 2: Untreated Allogeneic Blood Increases the Rates of Infection and Complications

Adapted from Murphy et al ⁷

Finally, in a follow-up of their previously reported study, Jensen and coworkers⁵ confirmed that the reduction in hospital length of stay afforded by providing patients with leukoreduced transfusion products correlated with a concomitant reduction in the cost of providing patient care (see Figure 3).

Figure 3: Cost Effectiveness of Pall Leukoreduction

Adapted from Jensen et al ⁵

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Summary of the Cost Effectiveness of Pall High Efficiency Leukocyte Reduction Filtration Technology

Pall’s line of leukocyte reduction filters cost-effectively condition blood components to significantly reduce the incidence of adverse transfusion reactions. Studies show that Pall filters can improve patient outcome, shorten hospital length of stay and significantly reduce the cost of care for patients requiring transfusion support.

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References

Ortolano GA. Potential for reduction in morbidity and cost with total leucocyte control for cardiac surgery. Perfusion 1995; 10: 283-290.
Jensen LS, et al. Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery. Brit J Surg 1992;79:513-516.
Jensen LS, Kissmeyer-Nielsen P, Wolff B, The Lancet. 1996;348:841-845.
van de Watering LMG, Leukocyte depletion reduces postoperative mortality in patients undergoing cardiac surgery. British Journal of Haematology. 1993; S2: 1182.
Jensen LS, Grunnet N, Hanberg-Sorensen F, Transfusion. 1995;35:719-722.
Kluytmans JAJW, Mouton JW, Maat APWM, Surveillance of postoperative infections in thoracic surgery. J Hosp Infection 1994;27:139-147.
Murphy P, Heal JM, Blumberg N. Infection or suspected infection after hip replacement surgery with autologous or homologous blood transfusion. Transfusion 1991;31:212-217.
Heiss MM, Mempel W, Delanoff, C, J Clin Oncol. 1994;12(9):1859-1867.
Edna TH, Bjerkset T. Association between blood transfusion and infection. J Trauma. 1992;33:659-661.
Triulzi DJ, Vanek K, Ryan DH, et al. Transfusion. 1992;32:517-524.

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