ContextA number of countries have implemented a policy of universal leukoreduction
of their blood supply, but the potential role of leukoreduction in decreasing
postoperative mortality and infection is unclear.ObjectiveTo evaluate clinical outcomes following adoption of a national universal
prestorage leukoreduction program for blood transfusions.Design, Setting, and PopulationRetrospective before-and-after cohort study conducted from August 1998
to August 2000 in 23 academic and community hospitals throughout Canada, enrolling
14 786 patients who received red blood cell transfusions following cardiac
surgery or repair of hip fracture, or who required intensive care following
a surgical intervention or multiple trauma.InterventionUniversal prestorage leukoreduction program introduced by 2 Canadian
blood agencies. A total of 6982 patients were enrolled during the control
period and 7804 patients were enrolled following prestorage leukoreduction.Main Outcome MeasuresAll-cause in-hospital mortality and serious nosocomial infections (pneumonia,
bacteremia, septic shock, all surgical site infections) occurring after first
transfusion and at least 2 days after index procedure or intensive care unit
admission. Secondary outcomes included rates of posttransfusion fever and
antibiotic use.ResultsUnadjusted in-hospital mortality rates were significantly lower following
the introduction of leukoreduction compared with the control period (6.19%
vs 7.03%, respectively; P = .04). Compared with the
control period, the adjusted odds of death following leukoreduction were reduced
(odds ratio [OR], 0.87; 95% confidence interval [CI], 0.75-0.99), but serious
nosocomial infections did not decrease (adjusted OR, 0.97; 95% CI, 0.87-1.09).
The frequency of posttransfusion fevers decreased significantly following
leukoreduction (adjusted OR, 0.86; 95% CI, 0.79-0.94), as did antibiotic use
(adjusted OR, 0.90; 95% CI, 0.82-0.99).ConclusionA national universal leukoreduction program is potentially associated
with decreased mortality as well as decreased fever episodes and antibiotic
use after red blood cell transfusion in high-risk patients.

https://jamanetwork.com/journals/jama/articlepdf/196395/JOC22222.pdf

Clinical Outcomes Following Institution of the Canadian Universal Leukoreduction Program for Red Blood Cell Transfusions

Estimating the cost of blood: past, present, and future directions.

Prevention of transfusion-transmitted infections.

Background Limited data suggest that higher hemoglobin thresholds for red-cell transfusions may reduce the risk of cognitive delay among extremely-low-birth-weight infants with anemia. Met...

https://www.nejm.org/doi/suppl/10.1056/NEJMoa2020248/suppl_file/nejmoa2020248_protocol.pdf

Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants

A prospective, randomized clinical trial of universal WBC reduction.

Universal WBC reduction.

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Universal WBC reduction.