Methods of Leukodepletion

  • Barry Wenz
Part of the Medical Intelligence Unit book series (MIUN)

Summary

This chapter reviews methods of production of leukocyte-depleted blood components, comments concerning the procedures used in the quality control of these products and a discussion of the proved and potential clinical benefits derived from the transfusion of these products in lieu of conventional white blood cell containing components. The advantages documented for the use of these products include a reduced incidence of nonhemolytic febrile transfusion reactions, a minimized rate of sensitization to HLA antigens and the accompanying immunological refractoriness to platelet transfusions and the provision of and a means to provide “cytomegalovirus” safe blood other than the traditional search for seronegative donors. The benefit of leukodepleted blood products in curtailing transfusion induced HTLV-I transmission, avoiding the immunomodulation which follows the receipt of blood and decreasing the rate of infection and tumor metastases which may be statistically associated with allogeneic blood transfusion are interesting possibilities that require prospective study. During the past three decades the technologies for the production of leukodepleted blood products have evolved from primitive procedures capable of removing less than 90% of the products’ native leukocytes to those that currently deplete −4 logl0 of the white cells. These techniques include sedimentation, centrifugation, cell washing, red cell freezing followed by deglycerolization, top and bottom component preparation systems and the use of laboratory and bedside filters. Although by definition not a leukocyte-depletion technique, ultraviolet irradiation of platelet concentrate has been recently shown to hold potential for reducing transfusion induced HLA sensitization. As the technologies to remove leukocytes from blood improve, so must the methods to qualify and monitor the production methods and products. At present the lower standard for leukodepleted components has been set at units containing no more than 106 white cells (U.S. standard, 5 x 106). Clinical studies may change these standards. Prototype filters are capable of now providing product containing as few as 103 leukocytes. The virtual elimination of all white cells from a blood component could conceivably justify new applications, such as products that lack the potential to elicit graft versus host disease.

The clinical use of leukocyte-depleted blood products (LDBP), specifically red cell (RCC) and platelet concentrates (PC), has dramatically increased in the past 10 years. A recent survey conducted by the College of American Pathologists (1993 CAP Surveys Set J-A) found approximately two-thirds of all facilities provide WBC reduced components to their clinical services and one-third of the responding institutions transfuse more than 10% of their cellular components as LDBP. The survey also confirmed that the majority of WBC reduced products are produced by filtration techniques. Improved efficiency and simplified production account for the increased use of LDBP. Increased use has led to numerous studies which confirm the clinical benefits derived from the use of these products.

Keywords

Cellulose Starch Glycerol Filtration Attenuation 

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© Springer-Verlag Berlin Heidelberg 1995

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  • Barry Wenz

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