RBCs Leukoreduced

RBCs leukoreduced are products in which the absolute WBC count in the unit is less than 5 _ 106 and must contain at least 85 percent of the original RBC mass per AABB Standards.77 There are two major categories of leukoreduced RBCs: prestorage and poststorage. In prestorage leukoreduction, special filters procure at least a 99.9 percent removal of leukocytes by employing multiple layers of synthetic nonwoven fibers that trap leukocytes and platelets but that allow RBCs to flow through. The impetus for prestorage leukoreduction involved biologic response modifiers (BRMs) released from leukocytes during storage of the component that were found to promote febrile transfusion reactions. Examples of BRMs include proinflammatory cytokines (interleukin-1, interleukin-6, and tumor necrosis factor) and complement fragments (C5a and C3a).78 There are three methods available in prestorage leukoreduction. In the first method, an in-line filter can be attached to the whole blood unit and filtered via gravity; RBCs and plasma can then be prepared. In the second method, plasma is initially removed from the whole blood unit, and then the blood is passed through an in-line reduction filter for the production of RBCs. In both these methods, random-donor platelets cannot be prepared as they would have been trapped in the filter. In the third method, a sterile docking device can be used to attach a leukocyte reduction filter to a unit of RBCs, which is allowed to flow via gravity. In poststorage leukoreduction, leukocytes are removed in the blood bank prior to issuing blood or at the bedside before transfusion. Whereas centrifugation can procure counts less than 5 _ 108, which can prevent most febrile hemolytic reactions to RBC concentrates, third-generation filters reduce leukocytes to levels of 5 _ 106 or lower. Removal of leukocytes by centrifugation or filtration just before transfusion of blood should prevent reactions that are caused by leukocyte antibody in patients plasma and leukocytes present in the transfused blood but will not prevent reactions caused by BRMs that originate from the leukocytes present in the component during storage. Studies suggest that the age of the RBC unit is a predictor of a febrile reaction and that the cytokine involvement may be cumulative.79 Leukocytes in transfusion have been associated with febrile nonhemolytic transfusion reactions and transfusion related acute lung injury as well as transmission of Epstein-Barr virus, CMV, and human T-cell lymphotrophic virus.

Filtration
Many types of filters are available that can produce an acceptable leukocyte-reduced product, depending on the purpose for the WBC reduction and the intended recipient. Third-generation filters use selective adsorption of leukocytes or leukocytes and platelets. They are made of polyester or cellulose acetate and will produce a 2- to 4-log (more than 99.9 percent) reduction of the WBCs (_5 _ 106) or platelets, or both. These filters provide a leukocyte-reduced product with normal shelf-life and meet the 85 percent retention of original RBCs.

Freezing, Deglycerolizing, and Saline Washing

RBCs that have been frozen, thawed, deglycerolized, and washed produce a leukoreduced product. Arnaud and Meryman80 recently discovered removal of the buffy coat at time of collection lowered the level of leukocytes to acceptable limits (1.9 _ 106) after freezing and deglycerolization; instituting such a protocol may provide a possible economic alternative to leukocyte filtration after freezing. Saline washing during deglycerolization ensures all donor plasma is removed and can be used for patients with paroxysmal nocturnal hemoglobinuria and IgA deficiency with circulating anti-IgA. This product has a shelf-life of 24 hours because it is an open system and requires special equipment to carry out the procedure.

Frozen, Deglycerolized RBCs

Freezing RBCs with glycerol dates back to the 1950s.81 Frozen RBCs can be stored for up to 10 years for those patients with rare phenotypes, for autologous use, and in the case of national emergencies in which blood cannot be dispositioned out to hospitals quickly enough to prevent expiration. The resulting deglycerolized product is free of leukocytes, platelets, and plasma due to the washing process. Cryoprotective agents can be categorized as penetrating and nonpenetrating. A penetrating agent involves small molecules