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Year : 2014  |  Volume : 5  |  Issue : 1  |  Page : 29-31

Leukodepletion status of blood products and transfusion reactions in thalassemic patients

1 Department of Clinical Pathology, St. Johns Medical College Hospital, Bengaluru, Karnataka, India
2 St. John's Medical College, Bengaluru, Karnataka, India

Date of Web Publication2-May-2014

Correspondence Address:
A M Shanthala Devi
Department of Clinical Pathology, St. Johns Medical College Hospital, Bengaluru, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1658-5127.131824

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Background and Objectives: Multi-transfused thalassemic patients are prone to transfusions related complications. Study of these reactions and correlating them with the leukodepletion of the transfused packed red blood cells (PRBCs) reduces transfusion complications due to the transfused leukocytes. Materials and Methods: This is a retrospective study carried out on 1152 transfusions in 161 thalassemic patients at our institute between January 2011 and December 2011. The total transfusions were classified into three categories depending on the leukodepletion status of the PRBC. The clinical records and the reaction workup done to rule out the hemolytic reactions were recorded. Results: Reactions were noted in three (0.2%) out of 161 thalassemic patients were recorded. Two reactions were recorded on transfusions of leukoreduced (buffy-coat method) and one reaction in nonleukoreduced PRBC, respectively. No reactions were recorded on transfusions leucodepleted done by bedside filter. Conclusion: Leukodepletion by using bedside filter is a better method for avoiding transfusion reactions. Though in resource limited settings, leukoreduction using the buffy-coat method is also effective in reducing the transfusion reactions. Leukoreduction of transfused blood cellular components in thalassemic patients is helpful in preventing transfusion reactions.

Keywords: Alloimmunization, beta thalassemia, febrile nonhemolytic transfusion reactions, leukodepletion/leukoreduction, transfusion transmitted infections, transfusion-related immunomodulation

How to cite this article:
Shanthala Devi A M, Gaikhonlungpou K G. Leukodepletion status of blood products and transfusion reactions in thalassemic patients. J Appl Hematol 2014;5:29-31

How to cite this URL:
Shanthala Devi A M, Gaikhonlungpou K G. Leukodepletion status of blood products and transfusion reactions in thalassemic patients. J Appl Hematol [serial online] 2014 [cited 2023 Mar 27];5:29-31. Available from: https://www.jahjournal.org/text.asp?2014/5/1/29/131824

  Background Top

Thalassemias are a heterogeneous group of inherited disorders [1] characterized by an imbalance in the synthesis of globin chains, which may result in the absence or reduction of the production of adult's hemoglobin. Treatment of thalassemias depends on the type and severity of the disease. Carriers (thalassemia trait), and thalassemia intermedia may not need regular blood transfusions, but beta thalassemia major transfusion-dependent from an early age in an attempt to maintain normal hemoglobin levels, and to prevent hyperstimulation of the bone marrow and its resultant complications. However, transfusion therapy leads to complications ranging from iron overload to a wide range of post-transfusion reactions. [2] Removal of leukocytes from transfused blood cellular products was shown to minimize febrile nonhemolytic reactions, human leukocyte antigen alloimmunization platelet refractoriness and also prevents the transmission of leukotropic viruses, such as cytomegalovirus, human T-cell leukemia virus, and Epstein Barr virus. [3]

This study was carried out on thalassemic patients who received multiple transfusions of packed red blood cells (PRBCs). We aim to correlate the transfusion reactions in these patients with the leukodepletion status of the transfused blood product.

  Materials and methods Top

This study was carried out over a period of 1 year from January 2011 to December 2011, on thalassemic patients who were transfused with PRBCs at our institute. All the thalassemic patients were given PRBC, and were divided into three categories according to the status of leucoreduction of the transfusion:

  • Leukodepletion by bedside filter
  • Leukoreduction by buffy-coat method
  • Nonleukoreduced blood.

All the transfusion records as well as the clinical charts were reviewed for evidence of any immediate transfusion reactions that occurred within 1 h of the commencement of the transfusion. In patients who had transfusion reactions, the reaction workup was checked to rule out the hemolytic reactions.

  Result Top

The outcome of the 1152 transfusions was analyzed as follows.

Transfusions using Bedside Filters

A total of 96 transfusions were performed using bedside filter; that is, 8.4% of the total 1152 transfusions. Thirteen thalassemic patients used bedside filter. About 38.4% (n = 5) patients used bedside filters regularly without any prior transfusion reactions. About 46.2% (n = 6) patients used bedside filters irregularly. About 15.4% (n = 2) patients started using bedside filter after experiencing transfusion reactions. Of the five patients who use bedside filter regularly, one patient developed red cell alloantibodies as evidenced by incompatible crossmatches resulting in the need for time-consuming crossmatch before compatible units could be found. No reactions were recorded in patients receiving bedside filtered PRBCs during the study period [Table 1].
Table 1: Categories of transfusions

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Transfusion using Buffy-Coat Leukoreduced Packed Red Blood Cell

A total of 886 transfusions were performed using leukoreduced PRBCs; that is 76.9% of the total 1152 transfusions. Transfusion reactions occurred in 0.26% (n = 3) of total transfusions and 1.8% (n = 3) of patients. 0.2% (n = 2) reactions occurred in patients receiving buffy-coat leukoreduced PRBCs.

Transfusions using Nonleukoreduced Blood

A total of 170 transfusions were done by nonleukoreduced PRBCs; that is 14.7% of the total 1152 transfusions. 0.58% (n = 1) reactions occurred in patients receiving nonleukoreduced PRBCs.

Of the total three transfusions reactions occurred, two of which were discontinued. The bags of the discontinued transfusions were sent to the blood bank for reaction workup and both did not show evidence of hemolytic transfusion reaction.

  Discussion Top

Thalassemia is a group of inherited blood disorders in which the beta thalasemias major management therapy depends on transfusions of PRBCs. Regular blood transfusions prevent patients from growth failure and other pathological consequences of severe anemia. [2],[3] Thalassemic patients need repeated transfusions over a period of time, and these makes them susceptible to various complications of blood transfusion, including leukocyte-mediated adverse effects. One approach to reduce this risk is leukocytes reduction of the transfused PRBCs.

In the current study, the transfusion of PRBCs was studied in a large cohort of thalassemic patients, and the transfusion reactions were correlated with the leukodepletion status of the blood products used. Transfusion reactions occurred in 0.26% (n = 3) of total transfusions in 1.86% (n = 3) of patients. 0.22% (n = 2) reactions occurred in category (B) and 0.58% (n = 1) reactions occurred in category (C). No untoward events were recorded in category (A) during the study period. 66.6% (n = 2) reactions were febrile nonhemolytic transfusion reactions (FNHTRs).

According to Sharma et al. [3] Macnamara et al. [4] and Shapiro, [5] leukoreduction decreases the incidence of adverse effect of leukocytes in PRBCs. In 2011, Bhattacharya et al., [6] in a study of 56,503 blood transfusions recorded a total of 105 adverse reactions of which 41% (n = 43) were FNHTRs. Earlier, in 1993, Tan et al. [7] studied 211 blood transfusions in 26 multi-transfused thalassemic children for over a 6 month period. Transfusion reactions occurred in 8.5% (n = 18) of transfusions in 42.3% (n = 11) of patients. 11.9% (n = 16) and 2.6% (n = 2) of reactions occurred in 50% (n = 9) and 25% (n = 2) of patients receiving buffy-coat-poor PRBC and filtered blood, respectively. Transfusion reactions were significantly reduced in the group receiving filtered blood (P < 0.05) [Table 2].
Table 2: Comparison of studies

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It is clear, therefore, that all published data agree that it is advisable to use blood filters for cellular transfusions in all thalassemics, especially prestorage filters; however, this would unavoidably increase the cost of transfusions. In a resource limited setting that cannot afford bedside filter; the FNHTRs can be reduced by using leukoreduced PRBC by the buffy-coat method. Besides, some modification in inventory management will enable the issue of exclusively leukoreduced safer blood to transfusion-dependent thalassemic patients.[8]

  Conclusion Top

Thalassemic patients require regular transfusions of PRBCs that is usually accompanied by many transfusion complications. Therefore, it is necessary to supply blood components that carry reduced risks of transfusion reactions in these patients. Leukocyte depletion by bedside filters has proved to be the most effective among the three categories, with no reaction recorded. However, the cost factor prevents all patients from using it. A simple buffy-coat method of leukoreduction, which is of low cost and reduces significantly transfusion reactions when compared to nonleukoreduced PRBC. In this way, it remains a good alternative to using bedside blood filters in a resource limited setups. This study has many limitations including being retrospective and did not look at the rate of under reported transfusion reactions, which is commonly seen in clinical practice. There is also the possibility that some reactions went un-noticed and therefore were not recorded.

  References Top

1.Sadeghian MH, Keramati MR, Badiei Z, Ravarian M, Ayatollahi H, Rafatpanah H, et al. Alloimmunization among transfusion-dependent thalassemia patients. Asian J Transfus Sci 2009;3:95-8.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.McKenzie SB. Anaemias caused by abnormalities in globin biosynthesis. In: Text Book of Hematology. 2 nd ed. Baltimore: Williams and Wilkins A Waverly Company; 1996. p. 164-7.  Back to cited text no. 2
3.Sharma RR, Marwaha N. Leukoreduced blood components: Advantages and strategies for its implementation in developing countries. Asian J Transfus Sci 2010;4:3-8.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.MacNamara E, Clarke S, McCann SR. Provision of leucocyte poor blood at the bedside. J Clin Pathol 1984;37:669-72.  Back to cited text no. 4
5.Shapiro MJ. To filter blood or universal leukoreduction: What is the answer? Crit Care 2004;8 Suppl 2:S27-30.  Back to cited text no. 5
6.Bhattacharya P, Marwaha N, Dhawan HK, Roy P, Sharma RR. Transfusion-related adverse events at the tertiary care center in North India: An institutional hemovigilance effort. Asian J Transfus Sci 2011;5:164-70.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.Tan KK, Lee WS, Liaw LC, Oh A. A prospective study on the use of leucocyte-filters in reducing blood transfusion reactions in multi-transfused thalassemic children. Singapore Med J 1993;34:109-11.  Back to cited text no. 7
8.Kumar H, Gupta PK, Mishra DK, Sarkar RS, Jaiprakash M. Leukodepletion and blood products. Med J Armed Forces India 2006;62:174-7.  Back to cited text no. 8


  [Table 1], [Table 2]

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