Journal of Blood Research & Hematologic Diseases.

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Letter to Editor,  J Blood Res Hematol Dis Vol: 1 Issue: 2

Efficiency of Pre-Storage Leukoreduction of Red Cells: A Double Blind Quality Control Method, Transfusion medicine

Setia Rasika1*, Arora Satyam1, Handoo Anil2 and Kapoor Meenu1
1Department of Transfusion Medicine, BLK Super Speciality Hospital, New Delhi, India
2Department of Lab Services, BLK Super Speciality Hospital, New Delhi, India
Corresponding author : Dr. Rasika D Setia
Department of Transfusion Medicine, BLK Super Speciality Hospital, New Delhi, India
Tel: +911130653093
E-mail: [email protected]
Received: August 25, 2016 Accepted:September 06, 2016 Published: September 08, 2016
Citation: Rasika S, Satyam A, Anil H, Meenu K (2016) Efficiency of Pre-Storage Leukoreduction of Red Cells: A Double Blind Quality Control Method. J Blood Res Hematol Dis 1:2. doi:10.4172/jbrhd.1000106

Abstract

White blood cell (WBC) reduction of whole blood (WB) with the use of in-line filters is a routine process at most blood centers in our country. The potential benefits by transfusing leukoreduced blood component are reduction in incidence of febrile nonhemolytic transfusion reactions as well as risk of human leukocyte antigen alloimmunization and cytomegalovirus transmission. We retrospectively analysed the efficiency of pre-storage leukoreduction at our center. Our analysis showed the applicability of the double blind method to evaluate the efficiency of the Inline leukoreduction of red cells. In-line pre-storage leukoreduction achieved 4log reductions in WBC resulting in acceptable numbers of WBC in the filtered units.

Keywords: White blood cell; Cytomegalovirus transmission

White blood cell (WBC) reduction of whole blood (WB) with the use of in-line filters is a routine process at most blood centers in our country. The potential benefits by transfusing leukoreduced blood component are reduction in incidence of febrile nonhemolytic transfusion reactions as well as risk of human leukocyte antigen alloimmunization and cytomegalovirus transmission. We retrospectively analysed the efficiency of pre-storage leukoreduction at our center. Our analysis showed the applicability of the double blind method to evaluate the efficiency of the Inline leukoreduction of red cells. In-line pre-storage leukoreduction achieved 4log reductions in WBC resulting in acceptable numbers of WBC in the filtered units.
White blood cell (WBC) reduction of whole blood (WB) with the use of in-line filters is a routine process at most blood centers in our country. The potential benefits by transfusing leukoreduced blood component are reduction in incidence of febrile nonhemolytic transfusion reactions as well as risk of human leukocyte antigen alloimmunization and cytomegalovirus transmission [1]. The American Association of Blood Banks [2,3] has defined standards for WBC reduction as WBC count of <5.5×106 (<1×106 in Europe) for a leukoreduced product. Our blood bank provides pre-storage leukoreduced blood components through in-line filters to all our patients. In this letter we would like to discuss the efficiency of pre-storage leukoreduction at our centre by a double blind method of quality control (Figure 1). A total of 10,517 whole blood donations were collected in the year 2015. Each month 1% of our collection or minimum 4 units were screened as per the national guidelines. Out of 10,517 donations, 134 (1.2% of our collection) leukoreduced packed red blood cells (LRPRBC) were screened for quality control purposes.
Figure 1: Double blind method for quality control testing.
Mean volume of LRPRBC’s prepared were 282 ± 1.4 ml whereas the pre WBC count and hematocrit of the donor were 7.5 ± 0.5×103/μL and 44.7 ± 0.4%. In-line leukoreduction quadruple bags were used from two companies Termo Penpol (Top and Bottom bag with In-line Leukocyte filter for RBC; n=16) and Fenewal (SAGM Top and Bottom bag with integral Leukocyte filter; n=118). LRPRBC were prepared within 2-4 hours of collection on refrigerated centrifuges (Heraeus Cryofuge 6000i; Rotor type 7617) at 4405 g with acceleration rate of 6 and deceleration rate of 2 at 22ºC for 8 minutes. Blood cell counts were done on LH750 Beckman Coulter (Florida, Miami, USA) and WBC quantification on BD FACS Caliber and using BD FACS Canto-II Flow-cytometer with Leucocount™ kits.
In order to evaluate the efficiency of the filters used a double blinding strategy was adopted. Selecting 5th, 10th, 15th and 20th donations on a fixed day of the week (Figure 1) for initial blinding step followed by second blinding step of testing of all the quality control parameters in a separate lab (Hematology). In our retrospective analysis, the mean WBC collected in the whole blood was 2114.6 ± 149 × 106 which on leukoreduction were reduced to 0.82 ± 1.1×106 achieving mean 99.9% leukoreduction (Table 1). The process of leukoreduction with in-line filters are reported to result in concomitant loss of red blood cells, in our analysis the mean red cell loss was about 19.2%. Pre-storage leukoreduction have shown to significantly reduce in unadjusted in-hospital mortality rates [4], post transfusion fever, use of antibiotics in these patients, platelet Alloimmunization [5], reduction in CMV transmission [6] and febrile non hemolytic transfusion reactions [7]. Providing universal leukoreduction is gradually becoming a requirement to support a tertiary care center. Equally important is to analyze the quality parameters of our LRPRBC.
Table 1: Details of WBC reduction and red cell recovery after leukoreduction by filtration.
Our analysis showed the efficiency of the In-line leukoreduction of red cells prepared at our centre. In-line pre-storage leukoreduction achieved 4log reductions in WBC resulting in acceptable numbers of WBC in the filtered units. Leukoreduction has been proven to be efficacious in reducing variety of adverse reactions to blood transfusion and should be adopted nationwide.

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