FEASIBILITY AND RATE OF LEUKOCYTE DEPLETION WITH A SINGLE LEUKOCYTE DEPLETION FILTER DURING MASSIVE TRANSFUSION

Background. The study examines the feasibility and rate of leucocyte d epletion with a single leucocyte depletion filter in combination with the Level 1 heat exchanging infusion/transfusion device H-500/H-25i du ring massive transfusions. Materials and Methods: LeukoGuard-6 filters (LG-6) were manufactured to fit the infusion sets of the Level 1 H-50 0/H-25i. This modified device was used intraoperatively in six patient s with severe haemorrhage. Following determination of the white cell c ounts (WCC) in each buffy coat poor red cell concentrate prior to admi nistration, WCC were then obtained from blood sampled directly distal to the filter after the first and after the last red cell concentrate was given. Leucocytes were determined in the Nageotte chamber and then calculated to determine leucocytes/250 ml (therapeutic unit). Paramet ers of feasibility (time for preparation of the system, the amount of transfused red cell concentrates, time interval of transfusions) were recorded. Results: The mean volume of red cell concentrates which were transfused and filtered by a single filter was 2,708 ml (S.D. +/- 797 ml) within a mean time interval of 42.5 min (S.D. +/- 26 min). With a mean WCC of 1.17 +/- 0.68 x 10(9) leucocytes/250 ml in the red cell c oncentrate prior to filtration the LG-6 achieved a log-3 reduction of leucocyte counts. During the transfusion the WCC distal to the filter increased on average by a factor of 3 (from 0.9 x 10(6) leucocytes/250 ml following the first blood unit to 2.7 x 10(6) leucocytes/250 ml fo llowing the last), but remained below 5 x 10(6). Conclusion: Modificat ion of the Level 1 H-500/H-25i system by incorporating the LG-6 leucoc yte depletion filter provides a significant reduction of the WCC in th e transfused red cell concentrates during massive transfusion. The rat e of leucocyte depletion by a single leucocyte depletion filter achiev es low leucocyte counts which are documented to be of therapeutical va lue. As the significance of leucocyte reduced blood products for patie nts with haemorrhagic shock following trauma or major surgery has stil l to be elucidated, the presented device may be useful in the performa nce of future studies related to this subject.