CHARACTERIZATION OF REACTIONS AFTER EXCLUSIVE TRANSFUSION OF WHITE CELL-REDUCED CELLULAR BLOOD COMPONENTS

Background: Potential adverse effects of white cells (WBCs) within tra nsfused cellular blood components include febrile nonhemolytic transfu sion reactions (FNHTRs), alloimmunization, transmission of infectious diseases, transfusion-related acute lung injury, and immunomodulation. Although exclusive use of WBC-reduced components to prevent alloimmun ization and cytomegalovirus transmission has been studied, the use of these components to avert FNHTR has not been examined. Study Design an d Methods: Transfusion reactions (FNHTRs allergic reactions, and other s) were characterized in recipients of 12,277 WBC-reduced single-donor apheresis platelets (SDAPs) and/or red cells (RBCs). Medical and labo ratory evaluations for possible infectious and immunologic (alloimmuni zation) causes of each reaction were undertaken, and the benefit of fu rther modification of components for the prevention of subsequent reac tions was also evaluated. Results: Transfusion reactions occurred afte r 481 (3.92%) of 12,277 transfusions. Allergic reactions occurred more commonly after transfusion of SDAPs (3.69%) than of RBCs (0.51%). Con versely FNHTRs occurred more commonly after transfusion of RBCs (2.15% ) than of SDAPs (1.58%). HLA antibodies were present in a posttransfus ion sample from 27 (10.6%) of 255 patients; bacterial contamination wa s a possible cause of only 2 (0.42%) of 481 reactions. In patients wit h recurrent FNHTRs, further WBC reduction in components did not wholly prevent further FNHTRs. Conclusion: The incidence of FNHTRs and alloi mmunization after exclusive transfusion of WBC-reduced RBCs and SDAPs was low. Further WBC reduction in components transfused to patients wi th a history of recurrent FNHTRs does not completely prevent subsequen t reactions.