Over 400 blood bank/technical staff attended our Corporate Evening symposium: Economic Road Maps to Universal Leukocyte Reduction, held in San Francisco during the 52nd American Association of Blood Banks (AABB) Annual Meeting. This program, available on audiocassette, provided the blood banking community with an overview of how hospitals, large and small, who have implemented universal leukocyte reduction at their facility, justified the cost and the benefits that resulted.

Our moderator for the evening, Joseph D. Sweeney, M.D., Blood Bank Medical Director and Associate Professor of Medicine for Brown University / The Miriam Hospital in Rhode Island, provided a brief overview of leukocyte reduction and introduced the concept of leukocyte reduction as a potential cost minimization strategy.

The following presentations were featured:

Introduction & Overview Joseph D. Sweeney, M.D. Moderator Blood Bank Medical Director and Associate Professor Medicine for Brown University / The MiriamHospital in Rhode Island The Economics of Leukocyte Reduction: From the Yale Perspective Edward L. Snyder, M.D., F.A.C.P. Professor Laboratory Medicine, Director Transfusion Services Yale-New Haven Hospital The Economics of Leukocyte Reduction: A View from the Hospital Blood Bank Nancy Chance MLT (ASCP), RMT Blood Bank Coordinator Riverview Hospital Making Universal Leukocyte Reduction Cost Neutral at a Large Academic Medical Institution Anne T. Thomas M.D. Director Blood Bank, Divisions of Hematology and Transfusion Medicine, Vanderbilt University Medical Center Leukocyte Reduction as a Cost Minimization Strategy in Transfused Medicare Patients Kathie Cunningham Manager Quality Assurance, Central Indiana Regional Blood Center, formerly Blood Bank Supervisor, Summit Medical Center

Customer Comments from attendees:

"I enjoyed the symposium. Well done. I picked up a few tips on how to sell leukocyte reduction to our financial people, especially reducing pool size. Our hospital is reviewing leukocyte reduction now. The hospital is about 30% bedside."

"I'm attending the symposium to help us find a way to pay for leukocyte reduction and not cut our staff."

" I learned that we can reduce our pool size. Everything else mentioned in the presentation we are doing. I came to hear about the practical knowledge of others. Thank you to Pall Medical for having the symposium."

"Great symposium. It was interesting to hear how others cost justify leukocyte reduction."

"We have a different funding system in Australia. Interesting to see how it's done in the US."

About the Presentation

The adoption of universal leukocyte reduction in many European countries to improve the safety of the blood supply is an emerging trend throughout the world. At the 51st AABB meeting in Philadelphia, PA, Pall sponsored a symposium to offer the medical community with the most current information on the impacting adoption of universal reduction worldwide.

The program presentations and guest speakers included:

Introduction & Overview Alvaro Monteiro, MD, Moderator Medical Director of Centro Hospitalar Vilanova do Gaiak, Porto, Portugal "Leukocyte Reduction: Rationale Methods, and Quality Control" Joseph D. Sweeney MD Medical Director, Blood Banks The Miriam and Roger Williams Hospital Associate Professor of Medicine Brown University, Providence, RI "Critical Appraisal of the Various Clinical Indications of Leukoreduction" Morris Bjachman MD Professor, Department of Pathology & Medicine McMaster University, Hamilton, Ontario "Universal Leukocyte Reduction: The Time is Now" Neil Blumberg MD Director, Transfusion Medicine Unit & Blood Bank Strong Memorial Hospital, Rochester, NY Questions and Answers Session

Customer Comments from attendees

"My reason for attending your event over other programs was due to the subject matter Pall was presenting. I am pleased with how the topics were discussed and must say that they drew my attention. The leukocyte reduction issue really has an impact on our business, we need to know what's going to happen next. Your mailer was an attention getter."

"You should know that we received invitations from Baxter and Hemasure. We selected Pall's evening because of the quality of the presenters and topics they discussed. It was impressive."

"Pall had quality presenters. I'm very pleased that I attended your evening. One thought for the future is to try to shorten the presentations a bit. In my opinion, some time could have been gained by shortening the talks given by the last few speakers."

"I received your mailer and liked it very much."

"I attended your program in complete support of Pall Medical. I want the company to know that there are a lot of people out there who think Pall is doing a great job in partnering with customers. We have to work together in this move. Hopefully Pall will help us out with the pricing. Your poster sessions honoring customers is quite impressive."

"Liked your mailer. I'm interested in having someone contact me about your blood bag systems."

"The draw was phenomenal."

This simple pamphlet clarifies the benefits of leukoreduction for each specific blood component along with their composition, indications for use and associated transfusion risks.

Summary Chart of Blood Components^17,18

Component	Composition	Indications	Risks	Benefits of Leukocyte Reduction
Whole Blood	red blood cells; plasma white blood cells; platelets (Note: red blood cells Hct~40%)	Symptomatic anemia with large volume deficit	Infectious diseases; septic/toxic, allergic, febrile reactions; circulatory overload; GVHD	Decreased incidence of: Febrile non-hemolytic transfusion reactions (FNHTR)8 Immunosuppression9,10, which may contribute to an increased incidence of postoperative infections11,12 and tumor recurrence13,14 Transmission or reactivation of intracellular viruses (i.e., cytomegalovirus [CMV] and human T-cell lymphotropic virus type I [HTLV-I])15,16
Red Blood Cells	red blood cells; reduced plasma; white blood cells; platelets (Note: red blood cells Hct~75%)	Symptomatic anemia	Infectious diseases; septic/toxic, allergic, febrile reactions; GVHD	Decreased incidence of: Febrile non-hemolytic transfusion reactions (FNHTR)8 Immunosuppression9,10, which may contribute to an increased incidence of postoperative infections11,12 and tumor recurrence13,14 Transmission or reactivation of intracellular viruses (i.e., cytomegalovirus [CMV] and human T-cell lymphotropic virus type I [HTLV-I])15,16
Red Blood Cells, (Adenine-Saline Added)	red blood cells; reduced plasma; white blood cells; platelets ~100 mL of additive solution (Note: red blood cells Hct~40%)	Symptomatic anemia	Infectious diseases; septic/toxic, allergic, febrile reactions; GVHD	Decreased incidence of: Febrile non-hemolytic transfusion reactions (FNHTR)8 Immunosuppression9,10, which may contribute to an increased incidence of postoperative infections11,12 and tumor recurrence13,14 Transmission or reactivation of intracellular viruses (i.e., cytomegalovirus [CMV] and human T-cell ymphotropic virus type I [HTLV-I])15,16
Fresh Frozen Plasma	plasma; all coagulation factors complement (no platelets)	Deficit of labile and stable plasma coagulation factors and TTP	Infectious diseases, allergic reactions, circulatory overload	Reduce contaminating white blood cells associated with the adverse transfusion reactions identified for whole blood
Liquid Plasma and Plasma	plasma; non-labile coagulation factors	Deficit of stable coagulation factors	Infectious diseases, allergic reactions	Decreased incidence of: Febrile non-hemolytic transfusion reactions (FNHTR)8 Immunosuppression9,10, which may contribute to an increased incidence of postoperative infections11,12 and tumor recurrence13,14 Transmission or reactivation of intracellular viruses (i.e., cytomegalovirus [CMV] and human T-cell lymphotropic virus type I [HTLV-I])15,16
Cryoprecipitated AHF	fibrinogen factors VIII and XIII; von Willebrand factor	Hemophilia A, von Willebrand’s Disease, Hypofibrinogenemia, Factor XIII deficiency	Infectious diseases, allergic reactions	Leukocyte reduction of this blood component is not recommended
Platelets, Concentrate (random donor)	platelets (>5.5 x 1010/unit); red blood cells; white blood cells; plasma	Bleeding from thrombocytopenia or platelet function abnormality	Infectious diseases; septic/toxic, allergic, febrile reactions, GVHD	Decreased incidence of: Alloimmunization, which may lead to platelet refractoriness if multiple and/or subsequent transfusions required2 Febrile non-hemolytic transfusion reactions (FNHTR)8 Immunosuppression9,10, which may contribute to an increased incidence of postoperative infections11,12 and tumor recurrence13,14 Transmission or reactivation of intracellular viruses (i.e., cytomegalovirus [CMV] and human T-cell lymphotropic virus type I [HTLV-I])15,16
Platelets, Pheresis	platelets; (>3 x 1011/unit); red blood cells; white blood cells; plasma
Granulocytes, Pheresis	granulocytes (>1.0 x1010 PMN/unit); lymphocytes; platelets (>2.0 x 1011/unit); some red blood cells	Neutropenia with infection	Infectious diseases, allergic reactions, febrile reactions, GVHD	Leukocyte reduction of this blood component is not recommended

References

1. Jensen LS, Kissmeyer-Nielsen P, Wolff B, et al. The Lancet. 1996; 348:841-845.
2. The Trial to Reduce Alloimmunization to Platelets Study Group. Leukocyte-reduction and ultraviolet B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusions. N Engl J Med 1997; 337:1861-9.
3. Jensen LS, Grunnet N, Hanberg-Sorensen F, et al. Transfusion 1995; 35:719-722.
4. Blumberg N, Heal JM, Kirkley SA, et al. American Journal of Hematology 1995; 48:108-115.
5. Sniecinski I. The impact of leukocyte reduced blood components on the cost of transfusion therapy in bone marrow transplantation. Presented at the 1993 Annual Meeting of the American Association of Blood Banks in Miami, FL.
6. Blumberg, N. Seminars in Hematology, Vol 34, No 3, Suppl 2 (July), 1997:pp34-40
7. U.S. Department of Health and Human Services, Blood Products Advisory Committee (BPAC) Meeting: 1998, #60.
8. Lane TA, Anderson KC, Goodnough LT, et al. Ann Intern Med. 1992; 117: 151-162
9. Triulzi DJ, Vanek K, Ryan DH, et al. Transfusion. 1992; 32: 517-524
10. Jensen LS, Kissmeyer-Nielsen P, Wolff B, et al. The Lancet. 1996; 348: 841-845
11. Heiss MM, Mempel W. Delanoff, C, et al. J Clin Oncol. 1994; 12(9): 1859-1867
12. Blumberg N, Agarwal MM, Chuang C. Br Med J. 1985; 290: 1037-1039
13. Busch MP, Lee T-H. Clinical Benefits of Leukodepleted Blood Products. Austin, TX: RG Landes Co; 1994
14. Sayers MH, Anderson KC, Goodnough LT, et al. Ann Intern Med. 1992; 116(1): 55-62
15. de Graan-Hentzen YCE, Gratama JW, Mudde GC, et al. Transfusion. 1989; 29:757-760
16. Bowden RA, Slichter SJ, Sayers M, et al. Blood 1995; 86: 3598-3603
17. American Association of Blood Banks Blood Transfusion Therapy – A Physician’s Handbook, 5th Edition 1996 pp 4-5.
18. Circular of Information For Use of Human Blood and Blood Components; AABB Op 1594, ARC 1751 4/94.

With the September 1998 recommendation of the Food & Drug Administration's (FDA) Blood Products Advisory Committee (BPAC) for universal leukocyte reduction, urgency has emerged to make leukocyte reduction a routine component processing step at the blood center. The information presented here can serve as a beginning by offering initial choices for blood component filtration options and considerations in compiling an implementation checklist in moving towards universal leukocyte reduction in the blood center.

The role and significance of leukocyte reduction by filtration of blood components was pioneered by the researchers and clinicians noted in this bibliography guide. Much has occurred in the few short years since the introduction of leukocyte reduction filters, thereby enhancing the purity and safety of the blood supply. This is evident by the growing list of countries which have chosen to leukocyte reduce 100% of their blood supplies. This bibliography compendium lists many of the authoritative papers that demonstrate the multi-factorial benefits of leukocyte reduction and related clinical significances. It is, however, by no means all-inclusive of what has been written on this subject. In fact, it represents only a microcosm of publications regarding the role of leukocyte reduction by filtration to reduce adverse transfusion reactions and improve patient outcomes. Pall will continue to encourage, monitor and support scientific research, as well as subsequent publications, to increase the understanding of leukocyte reduction by filtration.  (more)

Leukocyte reduction of blood has become an increasingly important part of transfusion medicine over the past several years. As technological advances are made in product performance and handling, questions arise regarding the various filters available for use during blood component processing in the blood center/hospital blood bank, as well as during administration of blood at the bedside. This booklet is intended to address these most frequently asked questions, as well as to provide a resource to understanding Pall Medical’s Leukotrap® and High Efficiency Leukocyte Reduction Filters.  (more)

Pall Corporation has manufactured high quality medical filters, blood storage systems and associated materials for clinical use for more than 25 years.  The key to Pall's technological leadership lies in decades of research and development experience and innovation related to media and filter design. This allows Pall to create materials that are designed for a specific application and available only in Pall products, supplied internationally.

Learn more about Pall's reliable and consistent filtration technology and how:

• Reliability by Design is built into every Pall blood filter, combined with rigorous high quality manufacturing and know-how.  
• Pall's reliable and consistent performance provide our customers with a safety margin well below the guidelines and standards. This provides our customers with a solid base that ensures consistency in the process.
• Pall provides dedicated support services for customers, including staff training, technical advice, and customer support tools, to help our customers achieve a consistent leukocyte reduction process.