Dosing and uses of Leukoreduced blood and components
Decreases Incidence of Febrile Transfusion Reactions
Please see specific component monograph (i.e., RBCs or Platelets) for dosing as there is no difference on dosing leukocyte reduced blood products from non-leukocyte reduced blood products
Other Indications
Decreases risk of CMV transmission to CMV negative immunocompromised or pregnant recipients
Decreases sensitization to HLA antigens (important for transplant patients and platelet transfusion refractoriness)
Pediatric dosage forms and strengths
Decreases Incidence of Febrile Transfusion Reactions
Please see specific component monograph (i.e., RBCs or Platelets) for dosing as there is no difference on dosing leukocyte reduced blood products from non-leukocyte reduced blood products
Leukoreduced blood and components adverse (side) effects
Frequency not defined
Hemolytic Transfusion Reactions
Febrile Non-Hemolytic Reactions
Allergic Reactions ranging from urticaria to anaphylaxis
Septic Reactions
Transfusion Related Acute Lung Injury (TRALI)
Circulatory Overload
Transfusion Associated Graft Versus Host Disease
Postransfusion Purpura
Warnings
Contraindications
Leukocyte reduction should not be performed for Granulocyte, Donor Lymphocyte Infusions, or Hematopoietic Progenitor Cell transfusions.
Cautions
Universal leukocyte reduction of blood components is common in many institutions but is not provided by all institutions. Therefore, leukocyte reduction should be included in the transfusion order for any patient that requires leukocyte reduced blood components.
Leukocyte reduction is NOT adequate for the prevention of TA-GVHD. Patients at risk of TA-GVHD should receive irradiated cellular components regardless of whether they are leukocyte reduced.
All transfusions must be given via blood administration sets containing 170- to 260-micron filters or 20- to 40-micron microaggregate filters even if the unit was previously leukocyte reduced via filtration. Additional filtration is not needed when transfusion is given via a bedside leukocyte reduction filter. No other medications or fluids other than normal saline should be simultaneously given through the same line without prior consultation with the medical director of the blood bank.
Patient’s should be monitored for signs of a transfusion reaction including vitals pre, during, and post transfusion.
Bedside leukocyte reduction has been associated with rare severe hypotensive episodes. These episodes have not been associated with pre-storage leukocyte reduced blood component transfusion. It is thought to be at least partially related to bradykinin generation and thus may be exacerbated by ACE Inhibitors.
Please see specific component monograph for full safety information.
Consult with blood bank medical director or hematologist if you have questions regarding special transfusion requirements.
Pregnancy and lactation
CMV-negative or CMV reduced risk (leukocyte reduced) RBCs should be used in pregnant women who are CMV-negative or whose CMV status is unknown. Consult with your blood bank medical director regarding your institutions policy for reducing CMV transmission in this population.
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Leukoreduced blood and components
Please see specific component monograph.
Mechanism of action
Leukocyte reduced components must have fewer than 5x106 WBCs for RBCs and apheresis (single donor) platelet units or fewer than 8.3x105 WBCs for whole blood derived (random donor) platelet units. Leukocyte reduction is achieved either using special leukocyte reduction filters or can be collected with equivalently low numbers of WBCs via particular apheresis collection protocols.
