Is leucodepleted (white blood cell reduced) blood better than leucoreduced (white blood cell reduced) blood for transplant patients?

Leukoreduced Blood Products for Transplant Patients

Leukoreduced blood products are recommended for transplant patients as they provide substantial benefits including reduced alloimmunization, decreased transfusion reactions, and reduced risk of cytomegalovirus transmission. 1

Benefits of Leukoreduction

• Leukoreduction significantly decreases the incidence of alloantibody-mediated refractoriness to platelet transfusion in patients receiving chemotherapy and stem cell transplantation 1
• Prestorage leukoreduction (performed at the time of blood collection) is now standard practice in the United States and many other countries, providing more consistent quality control 2
• Universal prestorage leukoreduction has been shown to reduce rates of alloimmune refractoriness from 14% to 4% in patients receiving chemotherapy for acute leukemia or stem cell transplantation 1
• Additional benefits include substantial reduction in transfusion reactions and prevention of cytomegalovirus transmission 1

Leukoreduction Methods

• Prestorage leukoreduction is preferred over bedside leukoreduction due to more consistent quality control 2
• Leukoreduction is achieved through filtration methods that remove white blood cells from blood components 3
• Filtration can result in some platelet loss (up to 25-35%), which may increase the number of transfusion products required 2
• The target for leukoreduction is typically less than 5 x 10^6 leukocytes per transfused unit 4

Clinical Applications for Transplant Patients

• Leukoreduced blood products are strongly recommended for all allogeneic hematopoietic stem cell transplant recipients 1
• Patients undergoing transplantation are at particularly high risk for alloimmunization and should receive leukoreduced products from the time of diagnosis 1
• For autologous transplant recipients, leukoreduced products are also recommended to reduce transfusion reactions and prevent HLA alloimmunization 1
• The American Society of Clinical Oncology provides a strong recommendation (evidence quality: high) for the use of leukoreduced blood products in transplant patients 1

Terminology Clarification

• The terms "leucodepleted" and "leukoreduced" are often used interchangeably in clinical practice 2, 4
• Both refer to the process of removing white blood cells from blood components through filtration 3
• There is no clinically significant difference between products labeled as "leucodepleted" versus "leukoreduced" - both terms indicate blood products that have undergone white blood cell reduction 2
• The critical factor is whether the leukoreduction was performed prestorage (at collection) or at bedside, with prestorage being preferred 2, 4

Practical Considerations

• Leukoreduction should be implemented from the beginning of treatment for transplant patients 1
• Both platelet and red blood cell products should be leukoreduced for optimal prevention of alloimmunization 1
• While leukoreduction adds cost to blood products, the benefits in preventing complications like febrile non-hemolytic transfusion reactions, alloimmunization, and CMV transmission justify its use in transplant patients 5, 6
• For patients requiring long-term transfusion support, as is common with transplant recipients, the benefits of leukoreduction are particularly important 1

In conclusion, leukoreduced blood products are strongly recommended for all transplant patients, with prestorage leukoreduction being the preferred method. The terms "leucodepleted" and "leukoreduced" can be used interchangeably, as they refer to the same process of white blood cell removal.