September 18, 1998

Hospital expands filtered blood’s use to all patients

Hospital expands filtered blood's use to all patients

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Dr. Anne Thomas manages VUMC's blood supply. (Photo by Donna Jones Bailey)

Vanderbilt University Medical Center has become one of the first academic medical centers in the nation ‹ and the only hospital in the region ‹ to expand the use of leukoreduced blood products to all patients.

These products are filtered to remove plasma and white blood cells, or leukocytes, which can carry disease, cause transfusion reactions and suppress the human body's immune system.

Previously, leukoreduced blood has been used only on those patients who require chronic transfusions or are very immune-suppressed, such as bone marrow transplant patients.

"Leukoreduced blood is going to become the standard for the entire nation," said Dr. Anne T. Thomas, assistant professor of Pathology and Medicine and director of Vanderbilt's Blood Bank. "In addition to being safer for patients it has the potential for saving money by reducing postoperative infections."

In September, VUMC became one of only a handful of institutions to expand the use of leukoreduced blood to all of its patients, instead of limiting their use to a few of the sickest patients.

One of the main concerns during transfusions for bone marrow transplant patients is the production of HLA antibodies, which can cause several problems following transfusion. They can cause fever, contribute to transplanted tissue rejection and render a patient unresponsive to vital platelet transfusions used to control or prevent bleeding.

In normal cases, white blood cells fight infection in the body. During blood transfusions or tissue transplants, the donor's white blood cells can induce the patient to form these HLA antibodies. The leukocytes can also produce reactions to blood products via chemicals cytokines that they release into the product during storage.

"White blood cells can also carry diseases such as cytomegalovirus (CMV), which most all of us carry and usually causes nothing more then a cold-type illness. In patients whose immune system is disturbed in some way, the virus can be fatal," said Thomas.

The risk of CMV has receded as hospitals began using leukoreduced blood for patients with compromised immune systems.

It is hoped that by using leukoreduced blood for a hospital's entire patient population, the number of postoperative infections and the amount of antibiotics used for each patient can be reduced.

"There have been studies that show leukoreduced blood helps reduce infections for patients undergoing elective surgeries. These were all very well controlled conditions. Further study of these blood products is needed to determine if they will help other patients in the hospital," said Thomas.

Trauma patients are one population that Thomas hopes to study once the leukoreduced blood is in use throughout the hospital. One of the major complications with these patients is that their injuries often lead to infection. These infections can be life threatening and often linger once the initial surgery is completed.

"Studying effects of this blood in the emergency room is something that we think is important even if we will not be able to have a double blind study," said Thomas.

The donation process itself will remain unchanged for those donating blood. After the blood is collected into one bag, it is then filtered into three different bags.

Once the process is complete there are three separate blood products in each bag: leukoreduced red blood cells, leukoreduced platelets, and leukoreduced plasma.

"If you ask a blood banker ‹ or really anyone who knows about blood products ‹ which they would rather get if they need a transfusion, they will tell you they want leukoreduced blood," said Thomas.

"This is not only better for our patients but in the long run could save us some money by reducing postoperative infections and the number of intravenous antibacterial drugs that we have to give our patients for those infections."