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Biologic effects of leukocytes present in transfused cellular blood
products
JO Bordin, NM Heddle and MA Blajchman
Department of Pathology, McMaster University, Hamilton, Ontario, Canada.
A considerable literature has accumulated over the past decade indicating
that leukocytes present in allogeneic cellular blood components, intended
for transfusion, are associated with adverse effects to the recipient.
These include the development of febrile transfusion reactions,
graft-versus-host disease, alloimmunization to leukocyte antigens, and the
immunomodulatory effects that might influence the prognosis of patients
with a malignancy. Moreover, it has become evident that such leukocytes may
be the vector of infectious agents such as CMV, HTLV-I/II, and EBV as well
as other viruses. An interesting development that has occurred
coincidentally in transfusion medicine is that agencies responsible for the
provision of blood products are being designated manufacturers of
biologicals. The trend among manufacturers of biologicals is to try to
produce pure products to provide for the specific therapeutic need of
patients. Thus, with the realization that allogeneic leukocytes and their
products may have adverse biologic activities, there is increasing pressure
from various sources for the reduction of the leukocyte content in
allogeneic blood components to minimize the occurrence of their adverse
effects. Although the threshold leukocyte number below which these effects
might no longer occur is still to be determined, a 2 to 3 log10 leukocyte
reduction, provided by the currently available commercial leukocyte
filters, has been shown to reduce the frequency of many of such reactions.
On the other hand, the immunosuppressive effects produced by the infusion
of allogeneic leukocytes might be beneficial for some patients, ie, for the
maintenance of kidney allografts, in possibly reducing the relapse rate in
patients with inflammatory bowel diseases, and in ameliorating recurrent
spontaneous abortion. Moreover, therapeutic granulocyte transfusions may be
of benefit in certain well- defined categories of patients infected with
bacteria, yeast, and/or fungi. These include neonates with bacterial sepsis
associated with bone marrow failure as well as severely neutropenic
leukemic patients with an infection unresponsive to appropriate and
specific antibiotic therapy. Many of the results obtained with the use of
leukocyte depletion filters are tantalizing, but the actual clinical
benefit of leukodepletion has not been established in most instances,
because much of the available data are retrospective or from uncontrolled
clinical trials. Moreover, issues of cost-effectiveness and quality control
have not been considered adequately. Properly designed prospective clinical
trials are essential to provide data with which to answer such questions
and also to help define the optimal conditions required for the preparation
of blood components ultimately destined for clinical use. Only with the
availability of such data can sound decisions be made about the clinical
value of leukodepletion.
Volume 84,
Issue 6,
pp. 1703-1721,
09/15/1994
Copyright © 1994 by The American Society of Hematology
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