King Karen E, Shirey R Sue, Thoman Sandra K, Bensen-Kennedy Debra, Tanz Warren S, Ness Paul M
Department of Pathology, Johns Hopkins Hospital, Baltimore, MD 21287-6667, USA.
Transfusion. 2004 Jan;44(1):25-9. doi: 10.1046/j.0041-1132.2004.00609.x.
Febrile nonhemolytic transfusion reactions (FNHTR) is a relatively common complication associated with allogeneic transfusion. Because WBCs have been implicated in the mechanism of FNHTRs, it has been proposed that the transfusion of leukoreduced RBCs should be associated with a decreased incidence of FNHTRs. These reactions are generally not life threatening, but they are expensive in their management, evaluation, and associated blood-product wastage. Over the past several years, the proportion of leukoreduced RBCs has increased at Johns Hopkins Hospital in an effort to move toward complete leuko-reduction. A retrospective analysis is reported here of FNHTRs in RBC recipients as the inventory increased in percentage of leukoreduced RBC units.
Between July 1994 and December 2001, all transfusion reactions (TRs) associated with the transfusion of allogeneic RBCs were retrospectively analyzed. Both computerized data and individual TR reports were reviewed. Patients who had both allergic and febrile features were included as part of both categories. TRs were reported as a percentage of total units transfused. Two time periods were selected for direct comparison. July to December 1994 represents the time period before the initiation of an increase in leuko-reduction. July to December 2001 represents a time period when almost complete leukoreduction (99.5%) had been achieved. The TR data were compared between these two time periods, comparing a time before leuko-reduction to a time period after leukoreduction had been achieved. The trends in TRs over the entire 7.5-year period of July 1994 to December 2001 were also assessed.
In the initial period before the initiative to move toward leukoreduction, 96 percent of our RBC inventory was non-leukoreduced. In the study period after leukoreduction, 99.5 percent of our RBC inventory was leukoreduced. When comparing these two time periods, the incidence of FNHTRs decreased from 0.37 percent to 0.19 percent (p = 0.0008). The trend over the entire 7.5-year study period confirms the decrease in FNHTRs as the percentage of leukoreduced RBCs increased. The incidence of allergic TRs has remained unchanged over this time period.
As our institution has increased its inventory of leukoreduced RBCs to approximately 100 percent, selective leukoreduced protocols have been discontinued. The incidence of FNHTRs has decreased significantly and the rate of allergic reactions has essentially remained unchanged. Leukoreduction is effective in decreasing FNHTRs associated with the transfusion of allogeneic RBCs.
发热性非溶血性输血反应（FNHTR）是同种异体输血相关的一种相对常见的并发症。由于白细胞被认为与FNHTR的发生机制有关，因此有人提出输注白细胞滤除的红细胞应能降低FNHTR的发生率。这些反应一般不会危及生命，但在管理、评估及相关血液制品浪费方面成本高昂。在过去几年中，约翰霍普金斯医院白细胞滤除红细胞的比例有所增加，以努力实现完全白细胞滤除。本文报告了随着白细胞滤除红细胞单位百分比增加，红细胞接受者中FNHTR的回顾性分析。
对1994年7月至2001年12月期间与同种异体红细胞输注相关的所有输血反应（TR）进行回顾性分析。审查了计算机化数据和个体TR报告。同时具有过敏和发热特征的患者被纳入这两类。TR报告为输注总单位数的百分比。选择两个时间段进行直接比较。1994年7月至12月代表白细胞滤除增加开始前的时间段。2001年7月至12月代表几乎实现完全白细胞滤除（99.5%）的时间段。比较这两个时间段的TR数据，即白细胞滤除前的时间段与实现白细胞滤除后的时间段。还评估了1994年7月至2001年12月整个7.5年期间TR的趋势。
在开始向白细胞滤除转变的初始阶段，我们96%的红细胞库存未经过白细胞滤除。在白细胞滤除后的研究阶段，我们99.5%的红细胞库存经过了白细胞滤除。比较这两个时间段时，FNHTR发生率从0.37%降至0.19%（p = 0.0008）。整个7.5年研究期间的趋势证实，随着白细胞滤除红细胞百分比的增加，FNHTR减少。在此期间，过敏TR的发生率保持不变。
随着我们机构将白细胞滤除红细胞库存增加到约100%，已停止选择性白细胞滤除方案。FNHTR的发生率显著降低，过敏反应发生率基本保持不变。白细胞滤除可有效降低与同种异体红细胞输注相关的FNHTR。
