Dzik W H, Anderson J K, O'Neill E M, Assmann S F, Kalish L A, Stowell C P
Blood Transfusion Service, Massachusetts General Hospital, Boston 02114, USA.
Transfusion. 2002 Sep;42(9):1114-22. doi: 10.1046/j.1537-2995.2002.00182.x.
Recipient exposure to allogeneic donor WBCs results in transfusion complications for selected populations of recipients. Whether or not WBC reduction should be universally applied is highly controversial.
In a general hospital, a randomized, controlled clinical trial of conversion to universal WBC reduction was conducted. Patients (11%) with established medical indications for WBC-reduced blood were not eligible. All other patients who required transfusion were assigned at random to receive either unmodified blood components or stored WBC-reduced RBCs and platelets. Analysis for each patient was restricted to the first hospitalization.
All eligible patients (n = 2780) were enrolled. Three specified primary outcome measures were not different between the two groups: 1) in-hospital mortality (8.5% control; 9.0% WBC-reduced; OR, 0.94 [95% CI, 0.72-1.22]; p = 0.64); 2) hospital length of stay (LOS) after transfusion (median number of days, 6.4 for control and 6.3 for WBC-reduced; p = 0.21); and 3) total hospital costs (median, $19,500 for control and $19,200 for WBC-reduced, p = 0.24). Secondary outcomes (intensive care LOS, postoperative LOS, antibiotic usage, and readmission rate) were not different between the two groups. Subgroup analysis based on patient age, sex, amount of blood transfused, or category of surgical procedure showed no effect of WBC reduction. Patients who received WBC-reduced blood had a lower incidence of febrile reactions (p = 0.06).
A beneficial effect of conversion from selective to universal WBC reduction was not demonstrated.
受血者接触异体供体白细胞会导致特定受血者群体出现输血并发症。白细胞减少是否应普遍应用极具争议。
在一家综合医院进行了一项关于转为普遍白细胞减少的随机对照临床试验。有明确医学指征需要输注白细胞减少血液的患者（11%）不符合条件。所有其他需要输血的患者被随机分配接受未处理的血液成分或储存的白细胞减少的红细胞和血小板。对每位患者的分析仅限于首次住院情况。
共纳入所有符合条件的患者（n = 2780）。两组在三项指定的主要结局指标上无差异：1）住院死亡率（对照组8.5%；白细胞减少组9.0%；比值比，0.94 [95%可信区间，0.72 - 1.22]；p = 0.64）；2）输血后住院时间（LOS）（中位数天数，对照组为6.4天，白细胞减少组为6.3天；p = 0.21）；3）总住院费用（中位数，对照组为19,500美元，白细胞减少组为19,200美元，p = 0.24）。次要结局指标（重症监护LOS、术后LOS、抗生素使用和再入院率）在两组之间也无差异。基于患者年龄、性别、输血量或手术类别进行的亚组分析显示白细胞减少无影响。接受白细胞减少血液的患者发热反应发生率较低（p = 0.06）。
未证明从选择性白细胞减少转为普遍白细胞减少有有益效果。
