Leukoreduction in Blood Transfusions

Primary Indications for Leukoreduction

The American Society of Clinical Oncology recommends leukoreduced blood products for patients with acute myeloid leukemia (AML) receiving induction chemotherapy, with high-quality evidence showing reduced alloimmunization and platelet refractoriness 1, 2
Leukoreduction is likely beneficial for patients with other types of leukemia receiving chemotherapy, based on expert consensus 1
Cancer patients receiving chemotherapy who will require multiple transfusions should receive leukoreduced blood products to prevent alloimmunization 1
Patients with aplastic anemia or myelodysplasia may benefit from leukoreduction, despite fewer direct studies 1

Leukoreduction reduces alloantibody-mediated refractoriness to platelet transfusion, with a significant reduction in HLA antibody formation and immune-mediated platelet refractoriness 2, 4
Leukoreduction decreases the incidence of febrile non-hemolytic transfusion reactions 3
Leukoreduction reduces the transmission of cytomegalovirus (CMV) infection 1

The decision to use leukoreduced blood should consider the expected duration of transfusion support, with most benefit for patients requiring multiple transfusions 2
The underlying disease is an important consideration, with the highest benefit in hematologic malignancies 1
Treatment intensity is also a factor, with patients receiving intensive chemotherapy benefiting most from leukoreduction 4
Age and gender are important considerations, particularly for younger patients who may need future transfusions 2

Most blood products are now leukoreduced at the time of collection (prestorage leukoreduction), eliminating the need for bedside filtration in most cases 1

RhD-negative children and women of childbearing age should receive either RhD-negative platelets or anti-D immunoprophylaxis when receiving platelets from RhD-positive donors to prevent RhD alloimmunization 5, 6

The Trial to Reduce Alloimmunization to Platelets (TRAP) demonstrated a significant reduction in HLA antibody formation and immune-mediated platelet refractoriness with leukoreduction 4
Despite the benefits of leukoreduction, only a small percentage of newly diagnosed AML patients may actually benefit clinically from leukoreduction during their treatment course 4
Leukoreduction adds cost to transfusion therapy, which is why it was historically reserved for specific patient populations 2