The effectiveness of prestorage leukocyte-reduced red blood cell transfusion on perioperative inflammatory response with a miniaturized biocompatible bypass system

Objective

Since 2007, the Japanese Red Cross Blood Center has provided prestorage leukocyte-reduced red blood cell concentrates in which the leukocytes were reduced soon after collection. We have established a miniaturized bypass system (140 mL) to reduce the perioperative inflammatory responses. This study was designed to reveal the effectiveness of leukocyte-reduced red blood cell concentrate transfusion on perioperative inflammatory responses in pediatric cardiac surgery.

Methods

Between May 2006 and June 2008, 50 consecutive patients weighing less than 5 kg who underwent a surgical procedure with red blood cell concentrate transfusion using a miniaturized bypass system were reviewed retrospectively. Twenty-five patients before 2007 received stored red blood cell concentrate in which leukocytes were reduced with a filter just before transfusion (group A). After 2007, 25 patients received the prestorage leukocyte-reduced red blood cell concentrate transfusion (group B). The postoperative peak C-reactive protein level, peak white blood cell count, peak neutrophil count, percentage body weight gain, inotrope score, plasma lactate concentration, postoperative mechanical ventilation time, and length of intensive care unit stay were compared as the perioperative inflammatory response and morbidity for both groups.

Results

There were no significant differences in peak white blood cell count, peak neutrophil count, percentage body weight gain, and inotrope score between the groups. The peak C-reactive protein level in group A was significantly greater than that in group B (6.7 ± 4.7 vs 4.2 ± 3.6 mg/dL, P < .05). The lactate concentration at 12 and 24 hours after surgical intervention in group A was significantly greater than that in group B (3.1 ± 2.5 vs 1.9 ± 1.1 mmol/L [P < .05] and 2.2 ± 0.2 vs 1.4 ± 0.2 mmol/L [P < .05], respectively). The postoperative mechanical ventilation time and intensive care unit stay in group A were significantly greater than those in group B (5.9 ± 7.4 vs 2.1 ± 2.0 days [P < .05] and 9.8 ± 7.9 vs 5.0 ± 2.1 days [P < 0.05], respectively). Multivariate analyses showed that the leukocyte-reduced red blood cell concentrate transfusion reduced the peak C-reactive protein level (in milligrams per deciliter; coefficient, −2.95; 95% confidence interval [CI], −4.66 to −0.93; P = .003), postoperative mechanical ventilation time (in days; coefficient, −3.41; 95% CI, −6.07 to −0.74; P = .013), and intensive care unit stay (in days; coefficient, −4.51; 95% CI, −7.37 to −1.64; P = .003).

Conclusions

Our study revealed that in neonates and small infants, compared with transfusions with stored red blood cell concentrate, transfusion of leukocyte-reduced red blood cell concentrates was associated with reduced perioperative inflammatory responses and improved clinical outcomes.

CTSNet classification: 20;21

Abbreviations and Acronyms: %BWG, percentage body weight gain, CPB, cardiopulmonary bypass, CRP, C-reactive protein, FFP, fresh frozen plasma, ICU, intensive care unit, ICUS, intensive care unit stay, p-CRP, peak C-reactive protein, PMEA, poly (2-methoxyethylacrylate), PMN, polymorphonuclear neutrophil, PMVT, postoperative mechanical ventilation time, p-NC, peak neutrophil count, p-WBC, peak white blood cell count, RACHS-1, Risk Adjustment in Congenital Heart Surgery, RBC, red blood cell, RCC-LR, leukocyte-reduced red blood cell concentrates, WBC, white blood cell count