Leukoreduction

This study examines the efficacy of various filtration techniques and compares their costs and their potential savings. More specifically, it compares the efficacy of various filtration techniques in reducing the leukocyte load of transfused blood components (apheresis platelets, pooled platelets and red blood cells), their cost, as well as the savings associated with a reduction in treating the adverse events related to transfused leukocytes. Adverse events examined include febrile reactions, platelet refractoriness following alloimmunization and immunomodulation. The efficacy of leukoreduction in reducing these adverse events was obtained from an extensive literature search of published literature complemented with a number of interviews with Canadian stakeholders. Level of evidence was assessed and indicated throughout the report. Canadian resource use and cost estimates were obtained from a number of Canadian sources. The efficacy of leukofiltrating three blood components (apheresis platelets, pooled platelets and red blood cells) was examined at three possible stages: in a regionl blood centre before storage of the blood component, in a hospital blood bank following storage and prior to delivering it to the requesting ward, and at a patient's bedside just before the transfusion. Thus, nine filtration techniques are assessed, each one having its own clinical efficacy and its cost. The cost f each of the nine filtration techniques was assessed in both single and multitransfused patients. This cost include the cost of filters, the cost of related activities such as inventory management and overhead costs and the cost of treating adverse reactions. It can be concluded that 100% filtration strategy is not cost-saving, whatever the timing of leukofiltration. However, for certain patient groups, notably those who require either frequent red blood cell or platelet transfusions, leukofiltration can be cost saving.