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Leukodepletion to Prevent Transfusion Reactions: Effects on Cytokines and Other Biologic Response Modifiers

  • Chapter
Clinical Benefits of Leukodepleted Blood Products

Part of the book series: Medical Intelligence Unit ((MIUN))

Summary

The role of allogeneic leukocytes in causing febrile nonhemolytic trans­fusion (FNHTR) reactions has been known since the mid-1950s. Recent data suggests plausible mechanisms in which pro-inflammatory cytokines (IL-lα, IL-1β, IL-6 and TNF-α) mediate the symptom com­plex of this reaction to blood transfusion. Furthermore, the source of these cytokines may be host leukocytes reacting to allogeneic leukocytes or donor leukocytes producing these cytokines in vitro during storage or in vivo post transfusion. Leukodepletion post-storage, reduces the occur­rence of FNHTRs by the former mechanism and pre-storage leukodeple­tion should be effective to prevent these reactions by either mechanism. Formal comparisons of pre-storage leukodepleted cellular products versus post-storage leukodepleted cellular products have not yet been performed.

The clinical features of hemolytic transfusion reactions may also be due to cytokines, but allogeneic leukocytes are not known to be impli­cated in the pathophysiology of these reactions. In transfusion related acute lung injury, a small percentage (6%) of occurrences may be caused by these cells. Allergic reactions are usually attributed to allogeneic solu­ble proteins, but particulate matter derived from leukocytes disintegrat­ing in vitro or substances produced by stored allogeneic leukocytes, such as IL-8 or histamine, may be important promoters. The role of leuko­depletion in amelioration of the above reactions is unknown. Transfu­sion-associated graft-versus-host disease is a rare but catastrophic adverse effect of blood transfusion due to donor T lymphocytes. Leukodepletion should theoretically prevent this reaction, but it is considered that the level of re­sidual leukocytes currently obtainable is not low enough to prevent this effect.

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Stack, G., Snyder, E.L. (1995). Leukodepletion to Prevent Transfusion Reactions: Effects on Cytokines and Other Biologic Response Modifiers. In: Clinical Benefits of Leukodepleted Blood Products. Medical Intelligence Unit. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-26538-3_6

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  • DOI: https://doi.org/10.1007/978-3-662-26538-3_6

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