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In Reply: We agree with Dr Wallis that the use of buffy coat–depleted RBCs before the policy was enacted might have diluted our observed mortality effect of prestorage leukoreduction. However, the 2 Canadian blood operators did not prepare buffy coat–depleted RBCs at any point during this time. Routine depletion of the buffy coat is not used in the preparation of blood components in North America. Some data, however, suggest that prestorage leukoreduction confers an incremental benefit over buffy-coat depleted RBCs.^1-2 In addition, animal studies provide evidence that depletion of the buffy coat imparts a partial transfusion-associated immunomodulatory effect less than that seen with prestorage leukoreduction.³ Thus, prestorage leukoreduction appears to provide a greater clinical benefit than either nonleukoreduced or buffy coat–depleted RBCs.

Financial Disclosure: Dr Blajchman serves on the Medical Advisory Board of the Pall Corporation.

For author affiliations, please refer to the original article (JAMA. 2003;289:1941-1949).—ED. . . [Full Text of this Article]

Dean Fergusson, MHA, PhD; Morris Blajchman, MD, FRCPC for the Leukoreduction Study Investigators

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Leukoreduction vs Buffy-Coat Depletion and the Safety of Blood Transfusion
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