Leukoreduction bedside vs. prefiltered

[nicole]

Our hospital is supplied by a blood center that does not universally leukoreduce their red blood cells. I have a two part question for anyone else in my position...

1. Are there any specific groups in your hospital that automatically receive leukoreduced blood (heme/onc, OHS, etc).

2. Do you receive LR blood directly from your supplier or do you use a leukoreduction filter at bed side? If you filter at bedside which filter do you use?

Any thoughts on leukoreduction in general would be great,

Thanks Nicole

[Jane]

Our blood supplier currently only produces pre-storage leukoreduced units (ARC Carolinas region) but prior to that we did the filters at bedside. At the time, we had it defined which patient populations would receive LR but I can't remember which now. Later, we looked at other suppliers that had both products available but our medical director thought that universal leukoreduction was an improvement in service and going back to units that weren't pre-storage leukoreduced would be a step back. It has made I think a huge difference in the # of febrile reactions.

[SMILLER]

We do not currently use LR RBCs for all patients. Our blood supplier agrees with our lab that we should, but the administration here still needs to be convinced that the extra $20 or so per unit is worth it. Everyone else in our geographic area already uses LR RBCs exclusively.

For now we use LR only if specifically ordered. If we have a recent history for a patient that suggests they still need LR products, will will call the ordering location to verify a non-LR order. These are primarily oncology or other immunocomprimised patients, and patients who have a history of febrile transfusion reactions.

Use of LR products leads to a decrease in post-op infections, and significantly lowers the risk of TACO and TRALI as well as febrile reactions. Bedside filtration is not as effective as pre-processes LR to avoid TRALI and TACO. There have been a numbers of studies over the years supporting this, as well as best-practice position papers put out by the FDA, AABB, etc.

Scott

[PAWHITTECAR]

We receive all leukoreduced but back when we did get both we had defined parameters. Hem/Onc, CVOR pts and those on ECMO automatically received LD units. I would suggest getting your transfusion commitee (if you have one) or other "physician" commitee involved in determining who needs this and set it up. Most computer systems will allow you to set attributes and "alarm" if they are not met/

[LCoronado]

We do not use LR universally (cost factor + low demand), but it is readily available from our blood supplier when specifically ordered by the physician. This works well for us as a small hospital, since often the order is for LR and irradiated, and possibly CMV negative; since we do not irradiate blood here or screen for CMV we would have to place a special order anyway. We do occasionally use filters at the bedside, for patients who have previously experienced febrile transfusion reactions. This is usually suggested by the pathologist who reviews the reaction workup. Once leukoreduced blood or a leukofilter is ordered, it is noted in the patient's history. When they present again, we often have to alert physician that this is what was done previously and let him/her make the call as to whether leukoreduced is indicated for the current event.

[ChrisH]

We are not 100% due to cost. We also keep pall filters just incase we have to use non leuko on a patiet that requires leuko filter. All our onc arw leuko reduced.

[heathervaught]

If you use a bedside leukoreduction filter, what type of quality control testing do you perform?

[David Saikin]

  If you LR at the bedside you are still going to transfuse a bunch of leukocyte metabolic products.  We used to go this route and found that Nursing had a difficult time with the process.  If you do it in the lab you will have to have some QA; if Nursing peforms this then I believe that QA becomes a moot point (it was that way 15 or so years ago - as for today, I am unsure).  We have been 100% LR since 1998.

[mpmiola]

In our service we no longer use filter bedside, but we filter after storage, in bench for QA terms.

I agree that pre-storage filter would be best, but still not able to implement it here.

[Deny Morlino]

We have been 100% leukoreduced for at least 10 years here as well.  For many years prior to that we had a hematologist / oncologist that had all of his units transfused with a filter prior to universal leukoreduction.  He was ahead of his time.

[tbostock]

We are also 100% LR. We felt the evidence was compelling enough to justify the cost.

And yes, as David stated above, the WBCs have already released cytokines, etc into the unit before you get to filter at the bedside. Pre-storage LR is a better method.

I would think if you're looking for categories: hem/onc, surgical, babies, patients with previous febrile reactions, frequently transfused patients (sickle cell, etc).