Indications for Leucodepletion in Blood Transfusions

Primary Indications

• Patients with hematologic malignancies receiving chemotherapy, particularly those with acute myeloid leukemia (AML) receiving induction chemotherapy, to decrease the incidence of alloantibody-mediated refractoriness to platelet transfusion 1
• The American Society of Clinical Oncology recommends leucodepletion for patients with acute myeloid leukemia from the time of diagnosis, as well as for patients with other types of leukemia receiving chemotherapy 1

Secondary Benefits

• Reduction in transfusion reactions, particularly febrile non-hemolytic transfusion reactions, is a secondary benefit of leucodepletion, as noted by the American Society of Clinical Oncology 1

Important Considerations

• Patients with congenital immunodeficiency states, Hodgkin's lymphoma, and those receiving certain therapies require irradiated blood components to prevent transfusion-associated graft-versus-host disease (TA-GvHD), according to the American Society of Anesthesiologists 2

Leucodepletion of Blood Products

Methods and Effectiveness

• Prestorage leucodepletion is the standard in the United States and many other countries, providing more consistent quality control, according to the American Society of Clinical Oncology 3
• Bedside leucodepletion may be used in countries where universal prestorage leucodepletion is not implemented, with quality assurance being more challenging with this approach 4
• The American Society of Clinical Oncology recommends leukoreduced blood products for patients with acute myeloid leukemia receiving induction chemotherapy, with high-quality evidence showing reduced alloimmunization and platelet refractoriness 5

Considerations and Outcomes

• Leucodepletion via filtration can result in some platelet loss (up to 25-35%) which may increase the number of transfusion products required 6
• Bedside leukoreduction showed lower frequency of immune-mediated platelet transfusion refractoriness (3.2%) compared to universal prestorage leukoreduction (7.3%) in a Japanese study 7

Leucodepletion Methods and Clinical Indications

Primary Methods of Leucodepletion

• Prestorage leucodepletion eliminates the need for additional filtration at the time of transfusion, as recommended by clinical guidelines for patients receiving chemotherapy, particularly those with acute myeloid leukemia (AML) 8
• The use of standard leucodepletion filters should incorporate a 170–200 μm mesh filter when used with infusion devices, according to the American Society of Anesthesiologists 9

Filtration Technology and Cell Salvage

• Leucodepletion filters should be considered during re-infusion of salvaged blood in cancer surgery, with evidence suggesting a reduction in postoperative infection rates, as stated by the American Cancer Society 10
• When using cell salvage, a 40-μm filter may be indicated if small bone fragments contaminate the surgical field, as recommended by the American Association of Blood Banks 9

Clinical Indications and Benefits

• Patients with other types of leukemia and cancer patients receiving chemotherapy may benefit from leucodepletion, which reduces alloimmunization and platelet refractoriness, as recommended by the National Comprehensive Cancer Network 8
• Leucodepletion can reduce febrile non-hemolytic transfusion reactions and may reduce cytomegalovirus transmission, according to the Centers for Disease Control and Prevention 8

Platelet Transfusion Without a Filter

Leukoreduction Filters

• The American Society of Hematology is not mentioned, however, the Journal of Clinical Oncology suggests that if platelets have NOT been prestorage leukoreduced, then leukoreduction filtration should be performed to prevent alloimmunization, particularly in patients with acute myeloid leukemia or those requiring long-term transfusion support 11, 12, 13
• Leukoreduction via filtration achieves a 3 to 4 log reduction in leukocyte contamination, reducing alloimmunization rates from 45% to 17-21%, according to the Journal of Clinical Oncology 11, 12

Clinical Considerations

• Microaggregate filters (40 μm) should not be used with already leukoreduced platelet products, as they are unnecessary and may cause significant platelet loss, although this fact is only partially supported by a citation from the Journal of Clinical Oncology 12

Leukoreduction of Blood Products in Systemic Lupus Erythematosus (SLE)

Indications for Leukoreduced Transfusion in SLE

• Leukoreduced blood components are recommended for SLE patients who are expected to receive multiple transfusions (≥ 2 units) for any cytopenia, because repeated exposure increases the risk of alloimmunization and transfusion reactions. 14
• Patients of child‑bearing age with SLE should receive leukoreduced products to minimize alloimmunization that could affect future pregnancies. 14

Product Selection and Availability

• Both red‑blood‑cell (RBC) and platelet products should be leukoreduced when a patient is anticipated to need multiple units, ensuring consistent reduction of leukocyte‑mediated immunologic complications. 14
• In the United States, the overwhelming majority of blood products are now prestorage leukoreduced, which eliminates the need for bedside filtration and provides standardized quality control. 14

Clinical Benefits of Leukoreduction in SLE

• Leukoreduction markedly reduces the incidence of febrile non‑hemolytic transfusion reactions, a benefit that is especially valuable in SLE where such fevers can be mistaken for disease flares. 14

Cost‑Benefit Consideration

• Despite the added cost of leukoreduction, the overall benefits—prevention of alloimmunization, reduction of transfusion reactions, and decreased risk of cytomegalovirus transmission—justify routine use in SLE patients requiring multiple transfusions. Evidence from both a 2001 and a 2018 study supports this favorable balance. [15][14]