Impact of Universal Leukoreduction on Febrile Reaction Rates in a Regional Blood Service

Norbert Valach; I. Ilavsky; M. Drexler

doi:10.5281/zenodo.22818731

Authors

Norbert Valach Department of Transfusion Medicine and Blood Banking, Weser Center for Stem Cell and Marrow Sciences Author https://orcid.org/8399-5976-4819-6430
I. Ilavsky Department of Cellular Therapy and Transplantation, Osam Institute of Applied Hematology Author https://orcid.org/7178-7011-9548-8249
M. Drexler Department of Transfusion Medicine and Blood Banking, Mures Institute of Blood Cancer Genetics Author https://orcid.org/1685-7368-2743-1466

DOI:

https://doi.org/10.5281/zenodo.22818731

Keywords:

leukoreduction, febrile non-hemolytic transfusion reaction, blood transfusion safety, hemovigilance, platelet storage

Abstract

Graphical abstract

Background: Febrile non-hemolytic transfusion reactions are the most commonly reported acute complication of cellular blood transfusion, attributed to leukocyte-derived cytokines and to antibodies against donor leukocyte antigens.

Objective: To synthesize the literature on the mechanism of febrile reactions and the effect of universal leukoreduction on reaction rates in blood services converting from selective to universal prestorage filtration.

Methods: Narrative review of cytokine studies, single-center cohort studies from the early-2000s implementation era, randomized trials, and national hemovigilance reporting.

Findings: Centers converting to universal prestorage leukoreduction reported reduced red cell febrile reaction incidence, one falling from 0.37% to 0.19%, while allergic reactions were unaffected; prestorage filtration prevents cytokine accumulation that bedside filtration cannot reverse, and residual risk concentrates in platelets and multiply-transfused recipients.

Conclusions: The febrile-reaction benefit of universal prestorage leukoreduction is consistent across mechanistic, cohort, and hemovigilance evidence, though moderate in size and specific to leukocyte-mediated reaction types.

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