Effectiveness of WBC reductions in neonates:: what is the evidence of benefit?

被引:14
作者
Fergusson, D
Hébert, PC
Barrington, KJ
Shapiro, SH
机构
[1] Univ Ottawa, Ottawa Hosp, Ctr Transfus Res, Ottawa, ON K1H 8L6, Canada
[2] Univ Ottawa, Ottawa Hosp, Dept Med, Ottawa, ON K1H 8L6, Canada
[3] Ottawa Hlth Res Inst, Clin Epidemiol Unit, Ottawa, ON, Canada
[4] McGill Univ, Dept Epidemiol, Montreal, PQ, Canada
[5] McGill Univ, Royal Victoria Hosp, Montreal, PQ H3A 1A1, Canada
关键词
D O I
10.1046/j.1537-2995.2002.00022.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: The presence of WBCs in RBCs is thought to be associated with a number of significant adverse effects in recipients. In adults, WBC reduction has been shown to reduce the frequency of HLA alloimmunization, CMV and HTLV infections, and febrile nonhemolytic transfusion reactions. However, neonates are unique, given that they have an immature immune system and are frequently transfused with RBCs. Thus, the aims of this systematic review were to determine whether WBC reduction of RBCs transfused to neonates decreases the transmission of CMV, reduces the ability to develop HLA antibodies, or reduces the risk of immunomodulation. In addition, nosocomial infection, mortality, and duration of stay were identified and analyzed. STUDY DESIGN AND METHODS: All studies of WBC reduction were identified by a systematic review of the literature. Studies meeting the inclusion criteria were grouped based on study outcome. Where appropriate, studies were pooled to obtain an overall measure of effect. RESULTS: Nine eligible studies were identified from the systematic literature search, and six were deemed evaluable. Two studies evaluated WBC reduction and the development of CMV, with different results. The pooled OR was 0.19 (95% Cl, 0.01-3.41), suggesting a clinical but nonsignificant effect. Two studies evaluated WBC reduction and HLA antibody development. As with CMV, the two studies were not congruent in their results. The pooled OR was 0.17 (95% Cl, 0.01-2.43). As for immunomodulation, two small studies presented evidence of a statistically significant change in lymphocyte subsets. No studies were identified with a primary objective of evaluating the impact of WBC reduction on nosocomial infection, mortality, or duration of stay. CONCLUSION: Current evidence suggests that WBC reduction may be effective in neonates; however, further studies are needed. The lack of convincing data and the significant cost of WBC reduction mandate evaluations to determine the clinical and economic impact.
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收藏
页码:159 / 165
页数:7
相关论文
共 33 条
[1]   CYTOMEGALOVIRUS INFECTIONS IN NEONATES ACQUIRED BY BLOOD-TRANSFUSIONS [J].
ADLER, SP ;
CHANDRIKA, T ;
LAWRENCE, L ;
BAGGETT, J .
PEDIATRIC INFECTIOUS DISEASE JOURNAL, 1983, 2 (02) :114-118
[2]  
BEDFORD RAR, 1993, ARCH DIS CHILD, V68, P49
[3]  
BOULTON JE, 1995, PEDIATR RES, V187, pA197
[4]   CYTOMEGALOVIRUS IMMUNE GLOBULIN AND SERONEGATIVE BLOOD PRODUCTS TO PREVENT PRIMARY CYTOMEGALOVIRUS-INFECTION AFTER MARROW TRANSPLANTATION [J].
BOWDEN, RA ;
SAYERS, M ;
FLOURNOY, N ;
NEWTON, B ;
BANAJI, M ;
THOMAS, ED ;
MEYERS, JD .
NEW ENGLAND JOURNAL OF MEDICINE, 1986, 314 (16) :1006-1010
[5]   Spongiform encephalopathies - B lymphocytes and neuroinvasion [J].
Brown, P .
NATURE, 1997, 390 (6661) :662-663
[6]  
*CCOHTA, 1998, LEUK INV TECHN US TH
[7]  
DICKERSIN K, 1995, SYSTEMATIC REV, P17
[8]   PREVENTION OF TRANSFUSION-ASSOCIATED CYTOMEGALOVIRUS-INFECTION IN NEONATAL PATIENTS BY THE REMOVAL OF WHITE CELLS FROM BLOOD [J].
EISENFELD, L ;
SILVER, H ;
MCLAUGHLIN, J ;
KLEVJERANDERSON, P ;
MAYO, D ;
ANDERSON, J ;
HERSON, V ;
KRAUSE, P ;
SAVIDAKIS, J ;
LAZAR, A ;
ROSENKRANTZ, T ;
PISCIOTTO, P .
TRANSFUSION, 1992, 32 (03) :205-209
[9]   Efficacy of leukocyte filters in the bypass circuit for infants undergoing cardiac operations [J].
Englander, R ;
Cardarelli, MG .
ANNALS OF THORACIC SURGERY, 1995, 60 (06) :S533-S535
[10]   RED FOR DANGER - BLOOD-TRANSFUSION AND COLORECTAL-CANCER [J].
FIELDING, LP .
BRITISH MEDICAL JOURNAL, 1985, 291 (6499) :841-842