Critical Care Medicine

Adult Critical Care

An association between decreased cardiopulmonary complications (transfusion-related acute lung injury and transfusion-associated circulatory overload) and implementation of universal leukoreduction of blood transfusions

Blumberg N, Heal JM, Gettings KF, et al (Univ of Rochester Med Ctr, NY) Transfusion 50:2738-2744, 2010^§

Abstract

Background

Cardiopulmonary adverse events after transfusion include transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO), which are potentially lethal and incompletely understood.

Study Design and Methods

To determine whether the incidence of TRALI and TACO was affected by leukoreduction we conducted a retrospective, before-and-after study of acute transfusion reactions for the 7 years before and after introduction of universal leukoreduction in 2000, involving 778,559 blood components.

Results

Substantial decreases occurred in the rates of TRALI (−83%; from 2.8 cases per 100,000 components before to 0.48 after universal leukoreduction; p = 0.01), TACO (−49%; 7.4 to 3.8 cases per 100,000; p = 0.03), and febrile reactions (−35%; 11.4 to 7.4 cases per 10,000; p < 0.0001). The incidence of allergic reactions remained unchanged (7.0 per 100,000 before and after universal leukoreduction). These outcomes were primarily attributable to decreased TRALI and/or TACO associated with red blood cell (RBC) and platelet (PLT) transfusions (−64%) with notably smaller decreases associated with fresh-frozen plasma or cryoprecipitate transfusions (−29%). The incidence of TRALI and/or TACO after 28,120 washed RBC and 69,325 washed transfusions was zero.

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