New Procedures Recommended for Improvement of Surgical Blood Transfusion

Clinical data supporting the use of leukocyte-reduced blood indicates a significant decrease in the risk of infection and cost of recovery in surgical patients, according to a panel of experts.

The millions of Americans who undergo surgery each year would benefit significantly from the use of leukocyte-reduced blood in transfusion, according to speakers at the recent American Society of Colon and Rectal Surgeons (ASCRS) meeting in Philadelphia. Currently reserved for transfusion in the highest-risk surgeries or cancer patients, leukocyte-reduced blood can significantly decrease the risk of infection, improve clinical outcomes, and decrease recovery time, as well as associated hospital costs with most surgical procedures.

“For surgical patients, transfusion-induced immunosuppression, which increases the risk of postoperative infection, is the single greatest mortality risk from transfusion,” said Neil Blumberg, MD, Strong Memorial Hospital, Rochester, New York. “Procedures that can minimize the risk of these infections, such as the routine use of leukocyte-reduced blood, should become a standard practice for all surgical patients requiring blood transfusions.” He added that the use of leukocyte-reduced blood for surgical patients would represent a potential annual savings of $6,000,000 to $12,000,000 for the US health-care system.

Leukocytes: Culprits of Infection

Blood transfusion has been linked with an increased occurrence of postoperative infections, such as pneumonia, wound infection, and sepsis. This increased risk has been shown in every surgical situation studied, including burn, cardiovascular, colorectal, hip, spinal, and trauma surgery.

“Since most people undergoing surgery are already sick, any measure that can eliminate the risk of additional infections, which can be life-threatening, should be adopted now,” said Richard Spence, MD, Staten Island University Hospital, New York. “Removing leukocytes from donor blood can be easily achieved through the use of blood filters either at the patient’s bedside or in the blood bank.”

Clinical Studies Indicate Reductions in Infection, Hospital Stay, and Costs

Lone Jensen, MD, Aarhus Municipal Hospital, Denmark, discussed the results of a study of 589 colorectal surgery patients that compared infection rates of leukocyte-reduced blood transfusions with allogeneic blood transfusions. She reported that when leukocyte-reduced blood was transfused, infection rates for pneumonia dropped from 23% to 3%. This rate of infection was identical to that seen in patients who received no transfusions. This study also showed that patients who received unfiltered blood had a significantly higher frequency of wound infection (12%) and rate of reoperation (16.9%) compared with patients who were transfused with leukocyte-reduced blood (0% and 3.5%).

A separate study of 915 cardiac surgery patients by van de Watering and coworkers found that leukocyte-reduced blood transfusions resulted in a noteworthy reduction in postoperative mortality by lowering the noncardiac causes of death in the study group. Noncardiac postoperative mortality was 7.6% with allogeneic blood compared with 2.5% with leukocyte-reduced blood by filtration.

“Allogeneic blood transfusion not only correlates with high infection rates but has also been significantly related to an increased length of hospital stay that is required to treat the infection,” stated Paul Tartter, MD, Mount Sinai Medical Center, New York. “Studies have shown a 15% to 35% reduction in hospital stay in surgical patients transfused with leukocyte-reduced blood. This translates into a significant reduction in the costs of hospital care.” Dr. Blumberg noted that the clinical data conclusively show that the use of leukocyte-reduced transfusions considerably decreases the risk of postoperative infections.