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UNIVERSAL LEUCODEPLETION

UNIVERSAL LEUCODEPLETION. DR. SANGEETA AGARWAL FORTIS MEMORIAL RESEARCH INSTITUTE GURGAON. Improvement of Transfusion Medicine Technology is an ongoing process. Six major paradigmatic shifts associated with transfusion medicine science & technology.

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UNIVERSAL LEUCODEPLETION

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  1. UNIVERSAL LEUCODEPLETION DR. SANGEETA AGARWAL FORTIS MEMORIAL RESEARCH INSTITUTE GURGAON

  2. Improvement of Transfusion Medicine Technology is an ongoing process. Six major paradigmatic shifts associated with transfusion medicine science & technology.

  3. Leukocytes (WBC) are Present in Varying Concentrations in all Cellular Blood Components

  4. LEUCODEPLETION To prevent adverse effects of leucocytes in blood components several methods have been developed to remove leucocytes Process is called Leucodepletion / Leucoreduction

  5. TYPES OF LEUCODEPLETION • Pre-Storage Leucodepletion – Blood Bank • Post-Storage Leucodepletion – Blood Bank Before Issue • Bedside Leucodepletion – Bedside

  6. METHODS OF LEUCODEPLETION • Cell Washing – 90% • Cell Freezing – 90% • Buffy Coat Removal – 90% • Micro Aggregate Filteration – 99% • Specific Leuco Filters – 99.9% • Leucodepleted Apheresis Products upto 99.9%

  7. LEUCODEPLETION

  8. Universal Leucodepletion (ULD) has been introduced in several countries Countries that have mandated Universal Leukocyte Reduction as a matter of Public Blood Safety Policy

  9. Why do we use Leukocyte Reduced Blood Products?

  10. Results from 3 Recent Studies on NHFTR to Red Cells and Platelets

  11. UNIVERSAL LEUCOREDUCTION DRAWBACKS High Cost Logistics

  12. Does it cost more to have blood filtered to remove white blood cells? • Though 10% to 20% added for filtration to the cost of preparing blood • But it helps in cost savings in hospital charges through reduced patient hospital stay As done in US, Saving the U.S. healthcare system six to twelve billion dollars per year for surgery patients alone

  13. SELECTIVE LEUCODEPLETION DRAWBACKS • Selection of a Patient Meeting the Criteria for Leuco-reduction • Physician Ignorance • Incomplete Hospital Database • Transfusion sites not aware of Leuco-reduction indications

  14. DRAWBACKS (CONTD.) • Inventory Management • Managing LD and Non LD blood units • How many units to leucodeplete? • In emergency non-availability of LD component may lead to mixed transfusion of LD and non LD components.

  15. SUMMARY

  16. Indications • Established Indications • Reducing recurrent febrile non-hemolytic transfusion reactions (FNHTR) • Reducing CMV transmission by cellular blood components • Reducing HLA alloimmunization • Patients receiving chemotherapy • Refractory to platelet transfusion • Multiple pregnancies • Chronic transfusion requirements • Immunosuppressed patients with CMV sero-negative test • Bone marrow transplant (BMT) • Premature neonateor infants less then 4 months • Peripheral blood progenitor cell transplant candidate or recipient • Renal transplant candidate or recipient; solid organ transplant recipient • Intrauterine transfusion • Hematologic malignancy

  17. Indications Under Review • Prevent TRALI due to passive administration of anti-leukocyte antibody • Prevent anaphylactic (hypersensitivity) transfusion reactions • Prevent hemolytic transfusion reactions • Prevent transfusion - Associated GVHD • Prevent alloimmunization and the refractory state to platelets • Reduce tumor recurrence rates after resection • Reduce postoperative wound infections and mortality • Prevent latent CMVreactivation • Prevent latent HIVreactivation • Prevent HLA alloimmunizationin organ or bone marrow transplant candidates

  18. Evidence of Various Studies  Method for decrease the incidence of transfusion-transmitted CMV • Use leukocyte-reduced blood components • Blood. 1995 Nov 1;86(9):3598-603. • Blood. 1996 Jun 1;87(11):4910 • Use CMV negative blood components  EBV • 4-log reduction of EBV genomic copy number can be achieved with leukoreduction of RBC units and renders most RBC units EBV-negative by sensitive PCR - Transfusion 2005 Apr;45(4):591-5

  19. Evidence of Various Studies  Chlamydia Pneumoniae • Leukoreduction with a filter is an effective method to significantly reduce resident C. pneumoniae levels in RBC components but may not be completely sufficient for total eradication of this pathogen - J ClinMicrobiol. 2005 Sep;43(9):4580-4  Pulmonary Tract Infections • Reduced the incidence of pulmonary tract infections in patients undergoing coronary artery bypass grafting - ActaCardiol. 2005 Jun;60(3):285-93 • Prestorageleukoreduction and low-temperature filtration reduce hemolysis of stored red cell concentrate - Transfusion. 2005 Jan;45(1):90-6

  20. CONCLUSION Associated clinical benefits of Leuco-reduction far outweigh the adverse features as Universal Leuco-reduction improves the transfusion safety which should extend to all patients receiving blood components

  21. “All scientific work is incomplete, whether it is observational or experimental. All scientific work is liable to be upset or modified by advancing knowledge. This does not confer on us a freedom to ignore the knowledge we already have, or to postpone the action that it appears to demand at a given time” Quoted by Sir Anthony Bradford Hill The Father of Randomized Controlled Trials

  22. When zero risk is the goal of transfusion medicine, all risks should be considered and the resources allocated for each, according to priority goals

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