 |
|
Clinical Outcomes Following Institution of the Canadian Universal Leukoreduction Program for Red Blood Cell Transfusions
Paul C. Hébert, MD, MHSc;
Dean Fergusson, MHA;
Morris A. Blajchman, MD;
George A. Wells, PhD;
Andrew Kmetic, MSc;
Doug Coyle, MSc;
Nancy Heddle, MSc;
Marc Germain, MD, PhD;
Mindy Goldman, MD;
Baldwin Toye, MD;
Irwin Schweitzer, MSc;
Carl vanWalraven, MD, MSc;
Dana Devine, PhD;
Graham D. Sher, MD, PhD; for the Leukoreduction Study Investigators
JAMA. 2003;289:1941-1949.
Context A number of countries have implemented a policy of universal leukoreduction of their blood supply, but the potential role of leukoreduction in decreasing postoperative mortality and infection is unclear.
Objective To evaluate clinical outcomes following adoption of a national universal prestorage leukoreduction program for blood transfusions.
Design, Setting, and Population Retrospective before-and-after cohort study conducted from August 1998 to August 2000 in 23 academic and community hospitals throughout Canada, enrolling 14 786 patients who received red blood cell transfusions following cardiac surgery or repair of hip fracture, or who required intensive care following a surgical intervention or multiple trauma.
Intervention Universal prestorage leukoreduction program introduced by 2 Canadian blood agencies. A total of 6982 patients were enrolled during the control period and 7804 patients were enrolled following prestorage leukoreduction.
Main Outcome Measures All-cause in-hospital mortality and serious nosocomial infections (pneumonia, bacteremia, septic shock, all surgical site infections) occurring after first transfusion and at least 2 days after index procedure or intensive care unit admission. Secondary outcomes included rates of posttransfusion fever and antibiotic use.
Results Unadjusted in-hospital mortality rates were significantly lower following the introduction of leukoreduction compared with the control period (6.19% vs 7.03%, respectively; P = .04). Compared with the control period, the adjusted odds of death following leukoreduction were reduced (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.75-0.99), but serious nosocomial infections did not decrease (adjusted OR, 0.97; 95% CI, 0.87-1.09). The frequency of posttransfusion fevers decreased significantly following leukoreduction (adjusted OR, 0.86; 95% CI, 0.79-0.94), as did antibiotic use (adjusted OR, 0.90; 95% CI, 0.82-0.99).
Conclusion A national universal leukoreduction program is potentially associated with decreased mortality as well as decreased fever episodes and antibiotic use after red blood cell transfusion in high-risk patients.
Author Affiliations: University of Ottawa Centre for Transfusion Research, and Clinical Epidemiology Program of the Ottawa Health Research Institute, Ottawa, Ontario (Drs Hébert and Wells, and Mssrs Fergusson, Kmetic, and Schweitzer); Department of Pathology, McMaster University and Canadian Blood Services, Hamilton, Ontario (Dr Blajchman); Clinical Epidemiology Program of the Ottawa Health Research Institute and the Department of Medicine, University of Ottawa, Ottawa, Ontario (Dr vanWalraven and Mr Coyle); Department of Medicine, McMaster University (Ms Heddle); Héma Québec, Québec City (Dr Germain); Héma Québec, Montréal (Dr Goldman);Department of Pathology and Laboratory Medicine, University of Ottawa (Dr Toye); Canadian Blood Services, Vancouver, British Columbia (Dr Devine); and Canadian Blood Services, Ottawa (Dr Sher).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED LETTER
Leukoreduction vs Buffy-Coat Depletion and the Safety of Blood Transfusion
Jonathan P. Wallis
JAMA. 2003;290(12):1580.
EXTRACT
| FULL TEXT
RELATED ARTICLES
Clinical Outcomes Following Institution of Universal Leukoreduction of Blood Transfusions for Premature Infants
Dean Fergusson, Paul C. Hébert, Shoo K. Lee, C. Robin Walker, Keith J. Barrington, Lawrence Joseph, Morris A. Blajchman, and Stan Shapiro
JAMA. 2003;289(15):1950-1956.
ABSTRACT
| FULL TEXT
Is Leukoreduction of Blood Components for Everyone?
Howard L. Corwin and James P. AuBuchon
JAMA. 2003;289(15):1993-1995.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Plasma from stored packed red blood cells and MHC class I antibodies causes acute lung injury in a 2-event in vivo rat model
Kelher et al.
Blood 2009;113:2079-2087.
ABSTRACT
| FULL TEXT
Loss of red cell chemokine scavenging promotes transfusion-related lung inflammation
Mangalmurti et al.
Blood 2009;113:1158-1166.
ABSTRACT
| FULL TEXT
Prevention and treatment of post-traumatic acute respiratory distress syndrome
Benfield et al.
Trauma 2007;9:255-266.
ABSTRACT
Association of RBC Transfusion With Mortality in Patients With Acute Lung Injury
Netzer et al.
Chest 2007;132:1116-1123.
ABSTRACT
| FULL TEXT
Controversies in RBC Transfusion in the Critically Ill
Hebert et al.
Chest 2007;131:1583-1590.
ABSTRACT
| FULL TEXT
Anaemia during critical illness
Walsh and Saleh
Br J Anaesth 2006;97:278-291.
FULL TEXT
Intensive care and emergency medicine: progress over the past 25 years.
Vincent et al.
Chest 2006;129:1061-1067.
ABSTRACT
| FULL TEXT
Prestorage Leukoreduction Prevents Accumulation of Matrix Metalloproteinase 9 in Stored Blood
Frake et al.
Arch Surg 2006;141:396-400.
ABSTRACT
| FULL TEXT
Anemia in the Long-term Ventilator-Dependent Patient With Respiratory Failure
Silver
Chest 2005;128:568S-575S.
ABSTRACT
| FULL TEXT
Understanding the Consequences of Transfusion-Related Acute Lung Injury
Shander and Popovsky
Chest 2005;128:598S-604S.
ABSTRACT
| FULL TEXT
Allogeneic red blood cell transfusions: efficacy, risks, alternatives and indications
Madjdpour and Spahn
Br J Anaesth 2005;95:33-42.
ABSTRACT
| FULL TEXT
Transfusion-Related Acute Lung Injury
Gajic and Moore
Mayo Clin Proc. 2005;80:766-770.
ABSTRACT
Transfusion Practice and Blood Stream Infections in Critically Ill Patients
Shorr et al.
Chest 2005;127:1722-1728.
ABSTRACT
| FULL TEXT
Anemia, Allogenic Blood Transfusion, and Immunomodulation in the Critically Ill
Raghavan and Marik
Chest 2005;127:295-307.
ABSTRACT
| FULL TEXT
Medical management of patients with multiple organ dysfunction arising from acute radiation syndrome
Jackson et al.
Br. J. Radiol. 2005;Supplement_27:161-168.
ABSTRACT
| FULL TEXT
Do Transfusions Get to the Heart of the Matter?
Hebert and Fergusson
JAMA 2004;292:1610-1612.
FULL TEXT
Evidence-Based Medicine in the ICU: Important Advances and Limitations
Vincent
Chest 2004;126:592-600.
ABSTRACT
| FULL TEXT
Transfusion-Related Acute Lung Injury: A Review
Looney et al.
Chest 2004;126:249-258.
ABSTRACT
| FULL TEXT
Medical Management of the Acute Radiation Syndrome: Recommendations of the Strategic National Stockpile Radiation Working Group
Waselenko et al.
ANN INTERN MED 2004;140:1037-1051.
ABSTRACT
| FULL TEXT
Double-Blind, Randomized Controlled Trial on the Effect of Leukocyte-Depleted Erythrocyte Transfusions in Cardiac Valve Surgery
Bilgin et al.
Circulation 2004;109:2755-2760.
ABSTRACT
| FULL TEXT
Effects of transfusion with red cells filtered to remove leucocytes: randomised controlled trial in patients undergoing major surgery
van Hilten et al.
BMJ 2004;328:1281.
ABSTRACT
| FULL TEXT
Leukoreduction vs Buffy-Coat Depletion and the Safety of Blood Transfusion
Wallis
JAMA 2003;290:1580-1580.
FULL TEXT
Is Leukoreduction of Blood Components for Everyone?
Corwin and AuBuchon
JAMA 2003;289:1993-1995.
FULL TEXT
The Hematologist and Radiation Casualties
Dainiak et al.
ASH Education Book 2003;2003:473-496.
ABSTRACT
| FULL TEXT
|
