The effect of prestorage WBC reduction on the rates of febrile nonhemolytic transfusion reactions to platelet concentrates and RBC


  • All figures in CDN Dollars. Cost per double collection bag for RBC without filter =$6.20, quad collection bag for PC without filter =$8.54, average =$7.37. Cost per bag for both RBC and PC collections with in-line filter =$42. Average additional cost per RBC and PC collection with in-line filter =$35. Cost of prestorage WBC reduction per FNHTR prevented =[(♯ units transfused/month × average additional cost) /♯ FNHTR prevented by prestorage WBC reduction]. Collection bag costs provided by personal communication with Pall Medical, May 2003.

From the Department of Laboratory Medicine and Pathology, University of Alberta; and Capital Health Transfusion Service, Edmonton, Alberta, Canada.

Mark Yazer, MD, 4B1.34 Walter Mackenzie Health Sciences Center, 8440-112 Street, Edmonton Alberta T6G 2B7 Canada; e-mail:


BACKGROUND:  Febrile non-hemolytic transfusion reactions (FNHTRs) are a common complication of platelet concentrate (PC) and RBC transfusions, usually ascribed to cytokines released by WBCs and perhaps the platelets themselves during storage. Prestorage WBC reduction should abrogate the accumulation of these cytokines reducing the number of FNHTRs.

STUDY DESIGN AND METHODS:  A retrospective analysis of FNHTR to PCs and RBCs before universal WBC reduction (PrUR) (July 1997-January 1998 for PCs, July 1997-July 1999 for RBCs) and after its introduction (PoUR) (February 1998-August 2001 for PC, August 1999-August 2001 for RBCs) was undertaken. All transfusion reactions were stratified based on component and date of reaction. Other adverse transfusion reactions were grouped into three periods: July 1997-January 1998, February 1998-July 1999, and August 1999-August 2001. A chi-square test was performed to determine the significance of the differences between groups.

RESULTS:  In the PrUR group, there were 231 FNHTRs in 70,396 RBC units transfused (0.33%) and 29 FNHTRs in 6502 PC units transfused (0.45% percent). In the PoUR group, there were 136 FNHTRs in 72,949 RBC units transfused (0.19%, p < 0.001) and 56 FNHTRs in 50,555 PC units transfused (0.11%, p < 0.001). Of the other adverse events, only TRALI reactions were sig-nificantly reduced.

CONCLUSION:  Prestorage WBC reduction significantly reduced the rate of FNHTRs to PCs and RBCs.