CHARACTERIZATION OF REACTIONS AFTER TRANSFUSION OF CELLULAR BLOOD COMPONENTS THAT ARE WHITE CELL REDUCED BEFORE STORAGE

Background: During the storage of cellular components before transfusi on, cytokines that may mediate transfusion reactions are released from white cells (WBCs). Adverse effects of transfused cellular blood comp onents therefore depend not only on the number of residual WBCs in blo od components, but also on the timing of WBC reduction. Study Design a nd Methods: Febrile nonhemolytic transfusion reactions (FNHTRs), aller gic reactions, and other reactions were characterized in recipients of 4728 units of red cells (RBCs) and 3405 bags of single-donor apheresi s platelets (SDAPs), all of which underwent prestorage WBC reduction. To delineate the impact of prestorage versus poststorage WBC reduction of RBCs on transfusion reactions, these results were compared with re actions occurring after the transfusion to similar recipients of 6447 bags of RBCs that underwent poststorage WBC reduction by bedside filtr ation and 5197 units of SDAPs that underwent prestorage WBC reduction. The levels of interleukin (IL) 1 beta, IL-6, IL-8, and tumor necrosis factor-alpha (TNF-alpha) were measured in a subset of 20 implicated c ellular blood components at the time of transfusion reactions and corr elated with the duration of storage before transfusion. Results: The i ncidence of reactions was greater after transfusions of SDAPs (5.49%) than of RBCs (1.63%). The incidence of FNHTRs after transfusion of RBC s that were WBC reduced before storage (1.1%) was significantly lower (p = 0.0045) than that after transfusion of RBCs that were WBC reduced after storage (2.15%). Although allergic reactions to RBCs that were WBC reduced before storage were also less common (0.41%) than those to RBCs that were WBC reduced after storage (0.51%), the difference was not significant (p = 0.067). At the time of reactions to RBCs and SDAP s that were reduced before storage, the level of IL-6 was negatively c orrelated (r = -0.54, p = 0.014) with the duration of storage before t ransfusion, and there was no correlation between the level of either I L-1 beta or IL-8 and the interval before transfusion. TNF-alpha was no t detectable in any implicated component. Conclusion: FNHTRs, but not allergic reactions, were less common after transfusion of RBCs that we re WBC reduced before storage than after the transfusion of those WBC reduced after storage at the bedside by filtration. The level of IL-6 in implicated cellular blood components that were WBC reduced before s torage was inversely correlated with the length of storage before tran sfusion. Further studies are needed to determine whether the transfusi on of cellular blood components that were WBC reduced before storage c an both diminish the incidence of adverse reactions and improve outcom e.