Use of leukoreduced autologous blood products

A blood banker in Southern California wonders if any colleagues are routinely leukocyte-reducing autologous RBC (or platelet) units. Her institution maintains a dual inventory of leukoreduced and non-leukoreduced ALLOGENEIC units, but a 100% inventory of NON-leukocyte reduced AUTOLOGOUS units. Her institution has a policy to give leukoreduced allogeneic units to heart surgery patients, cancer patients, and other frequently transfused patients (sickle cells, dialysis), as well as to those patients who have had previous febrile reactions. However, if any of those patients banked their own autologous blood, their autogous transfusion would be non-leukocyte reduced. Since her staff occasionally errs and fails to select a leukocyte-reduced allogeneic product for a patient who should get one, she is thinking of converting their entire RBC and platelet inventory to 100% leukoreduced to avoid such a mishap. She acknowledges that nearly 60% of the autologous units that they collect on site are not transfused, and she would hate to go to the effort and expense of leukoreducing autologous units that are not used. However, she would consider leukoreducing autologous units for heart patients (and possibly other patients as well) if experience in the field and the literature supported it.

The Editor recommends review of a similar issue posted on this forum in 1999, when the subject of universal leukoreduction was first being discussed.

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ADDENDA Mar. 16, 2005

The following comments have been received.

1. Dr. Breanndan Moore of the Mayo Clinic in Rochester MN (attribution used with permission) reports that they recently converted their cellular blood product inventory to an all-leukoreduced supply. He acknowledges their rationale as follows;
   • An ever growing proportion of transfused patients have established indications for leukoreduction, e.g. Transplants, immunocompromised, need for CMV protection, neonates etc.
   • They already reached a point where about 70% of their platelets were leukoreduced (either apheresis or random pools) and about 50% of their RBCs were leukoreduced.
   • Partly due to maintaining a "dual" blood supply (leukoreduced and non-leukoreduced) and partly due to medical or surgical residents forgetting to order leukoreduced products when indicated, they were beginning to see situations where patients who really should have been getting leukoreduced blood products, did not always receive them.
   • They recognized that the list of clinical situations where leukoreduction was considered likely to be beneficial to patients, was growing.
   • They could greatly simplify the blood ordering, blood processing, labeling and storage by eliminat