Universal Leukoreduction - Hospital Viewpoints

If you recall, a member requested a survey of prevailing opinion regarding the universal use of leukocyte reduced cellular blood components. Institutional opinions were solicited with the knowledge that the responses would be compiled and be presented as aggregate data at the upcoming AABB meeting in San Francisco. Here are the responses, as promised, but with slight paraphrasing to protect the specific identities of the submitting institutions.

1. At one hospital in Los Angeles, there were concerns over the increased product cost. This hospital does use leukoreduced products for their transplant and oncology patients. They feel that leukocyte reduction provides a better product for any patient. but the product cost needs to be considered as well.
   
   
2. Another hospital in Los Angeles (a major Level I Trauma center county hospital with just under 300 beds) states that most of their blood inventory comes from the Red Cross. Because the price differential is $52 for leukoreduced red cells, this hospital is unable at this time to completely convert to 100% leukoreduced blood products, until universal leukoreduction is implemented.
   
   
3. At a third Los Angeles institution, they do not plan to go to universal leukocyte reduction unless mandated by the FDA. That hospital provides leukocyte reduced products for those patients for whom they feel there is a defined indication. Since a large proportion of that hospital's platelets are transfused to heme/onc patients, their platelets are leukocyte reduced for the prevention of alloimmunization. About 30% of that hospital's Red Cells are leukocyte reduced and to provide the rest as leukocyte reduced would cost the hospital ~$500,000 per year. Further, this hospital objects to the possibility of a mandate as an intrusion on the ability of physicians to practice medicine. Incidentally, this hospital's opinion is that physicians should be given a choice as to whether to prescribe leukocyte-reduced blood products for their patients. This hospital does not expect that there will be government funding to compensate for the expense of the mandate.
   
   
4. A fourth Southern California institution believes that universal leukoreduction is a goal towards which we all should strive. It may take another year or two to get there, but it will be worth the trip. It makes more sense than HIVag screening, CJD screening, and a host of other things we do.
   
   
5. A fifth Southern California institution (a blood center) is in favor of leukoreducing all allogeneic RBC and Platelet products prior to storage. At present, this blood center is not convinced that autologous or non-cellular products should be leukoreduced.
   
   
6. A sixth Southern California institution (and another blood center) responds that they support universal prestorage leukocyte reduction of all cellular blood components, with a proviso that these products be provided in the most cost-sensitive way possible. This blood center feels that prestorage leukocyte reduced cellular products are the best products for patients to receive.
   
   
7. A Northern California blood center is not yet performing universal leukocyte reduction but is planning for it next year. Hospitals in that blood centers service area should be prepared for this product line, and should budget accordingly.
   
   
8. Finally, a second Northern California institution (a hospital) is not planning to go to universal leukocyte reduction, unless mandatory. This is because third party reimbursement for blood products is already less than the cost of the products. It has been the feeling of this hospital's physicians that the currently established medical benefits of leukocyte reduction are insufficient to justify the immense incremental cost to the institution of applying this technology to all patient.

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