open access

Vol 13, No 2 (2020)
Review paper
Published online: 2020-10-05
Get Citation

LEUKOCYTES AND PATHOGEN INACTIVATION METHODS

Elżbieta Lachert
Journal of Transfusion Medicine 2020;13(2):105-112.

open access

Vol 13, No 2 (2020)
REVIEWS
Published online: 2020-10-05

Abstract

Transfusion of blood components with residual leukocytes may lead to a number of adverse reactions based on two separate immune-mediated mechanisms. Such complications include transfusion associated - graft versus host disease (TA-GvHD), febrile nonhemolytic transfusion reactions (FNHTRs), which are caused by release of cytokines and recipient alloimmunization with HLA antigens. This leads to anti-HLA antibody formation in the recipient and may induce refractory response to the transfused platelet concentrate (PC). To reduce the risk of transferring residual leukocytes with transfused blood components, for many years now various preparation methods have been applied, which contribute to reduction of white blood cell (WBC) count or to leukocyte inactivation. These methods are: leukoreduction, gamma irradiation and pathogen inactivation methods. Advancement of research on pathogen inactivation in blood components has demonstrated that some of the methods used for the routine pathogen inactivation in plasma and platelet concentrate ( Mirasol®PRT system and Intercept) may also be effective for inactivation of T lymphocytes. These methods may therefore serve as alternative to irradiation. Also the inactivation method with UVC light when implemented into routine use, may replace the commonly used irradiator. Inactivation methods were found not only effective for protection against TA-GvHD, but also for inhibiting cytokine synthesis, primarily responsible for febrile nonhemolytic transfusion reactions.

Abstract

Transfusion of blood components with residual leukocytes may lead to a number of adverse reactions based on two separate immune-mediated mechanisms. Such complications include transfusion associated - graft versus host disease (TA-GvHD), febrile nonhemolytic transfusion reactions (FNHTRs), which are caused by release of cytokines and recipient alloimmunization with HLA antigens. This leads to anti-HLA antibody formation in the recipient and may induce refractory response to the transfused platelet concentrate (PC). To reduce the risk of transferring residual leukocytes with transfused blood components, for many years now various preparation methods have been applied, which contribute to reduction of white blood cell (WBC) count or to leukocyte inactivation. These methods are: leukoreduction, gamma irradiation and pathogen inactivation methods. Advancement of research on pathogen inactivation in blood components has demonstrated that some of the methods used for the routine pathogen inactivation in plasma and platelet concentrate ( Mirasol®PRT system and Intercept) may also be effective for inactivation of T lymphocytes. These methods may therefore serve as alternative to irradiation. Also the inactivation method with UVC light when implemented into routine use, may replace the commonly used irradiator. Inactivation methods were found not only effective for protection against TA-GvHD, but also for inhibiting cytokine synthesis, primarily responsible for febrile nonhemolytic transfusion reactions.
Get Citation

Keywords

leukocytes, pathogen inactivation methods, serious adverse reactions

About this article
Title

LEUKOCYTES AND PATHOGEN INACTIVATION METHODS

Journal

Journal of Transfusion Medicine

Issue

Vol 13, No 2 (2020)

Article type

Review paper

Pages

105-112

Published online

2020-10-05

Bibliographic record

Journal of Transfusion Medicine 2020;13(2):105-112.

Keywords

leukocytes
pathogen inactivation methods
serious adverse reactions

Authors

Elżbieta Lachert

References (35)
  1. Dasararaju R, Marques MB. Adverse effects of transfusion. Cancer Control. 2015; 22(1): 16–25.
  2. Yazer MH, Podlosky L, Clarke G, et al. The effect of prestorage WBC reduction on the rates of febrile nonhemolytic transfusion reactions to platelet concentrates and RBC. Transfusion. 2004; 44(1): 10–15.
  3. Pogłód R. Poprzetoczeniowa choroba-przeszczep przeciw gospodarzowi. Acta Haematologica Polonica. 2009; 40(2): 425–434.
  4. Fast LD. Developments in the prevention of transfusion-associated graft-versus-host disease. Br J Haematol. 2012; 158(5): 563–568.
  5. Dwyre DM, Holland PV. Transfusion-associated graft-versus-host disease. Vox Sang. 2008; 95(2): 85–93.
  6. Mintz PD, Wehrli G. Irradiation eradication and pathogen reduction. Ceasing cesium irradiation of blood products. Bone Marrow Transplant. 2009; 44(4): 205–211.
  7. Akahoshi M, Takanashi M, Masuda M, et al. A case of transfusion-associated graft-versus-host disease not prevented by white cell-reduction filters. Transfusion. 1992; 32(2): 169–172.
  8. Fast L. Preventing transfusion-associated graft-versus-host disease: state of the art. International Journal of Clinical Transfusion Medicine. 2015: 1.
  9. Lachert E. : Poprzetoczeniowa choroba przeszczep przeciwko gospodarzowi (Ta-GvHD), Laboratorium Medyczne. 2019; 2: 25–29.
  10. Corash L, Lin L. Novel processes for inactivation of leukocytes to prevent transfusion-associated graft-versus-host disease. Bone Marrow Transplant. 2004; 33(1): 1–7.
  11. Grass JA, Hei DJ, Metchette K, et al. Inactivation of leukocytes in platelet concentrates by photochemical treatment with psoralen plus UVA. Blood. 1998; 91(6): 2180–2188.
  12. Lachert E. : Zapobieganie poprzetoczeniowej chorobie przeszczep przeciwko gospodarzowi (Ta-GvHD), Laboratorium Medyczne. 2019; 3: 35–40.
  13. Obwieszczenie Ministra Zdrowia z dnia 6 marca 2019 r. w sprawie wymagań dobrej praktyki pobierania krwi i jej składników, badania, preparatyki, przechowywania, wydawania i transportu dla jednostek organizacyjnych publicznej służby krwi.
  14. Fast LD, Dileone G, Li J, et al. Functional inactivation of white blood cells by Mirasol treatment. Transfusion. 2006; 46(4): 642–648.
  15. Hod E, Schwartz J. Platelet transfusion refractoriness. Br J Haematol. 2008; 142(3): 348–360.
  16. Eisenberg S. Refractory response to platelet transfusion therapy. J Infus Nurs. 2010; 33(2): 89–97.
  17. Ohto H. Gamma radiation does not prevent transfusion-induced HLA alloimmunization. Transfusion. 1997; 37(8): 878–879.
  18. Muylle L, Peetermans ME. Effect of prestorage leukocyte removal on the cytokine levels in stored platelet concentrates. Vox Sang. 1994; 66(1): 14–17.
  19. Paglino JC, Pomper GJ, Fisch GS, et al. Reduction of febrile but not allergic reactions to RBCs and platelets after conversion to universal prestorage leukoreduction. Transfusion. 2004; 44(1): 16–24.
  20. Picker SM, Steisel A, Gathof BS. Evaluation of White Blood Cell- and Platelet-Derived Cytokine Accumulation in MIRASOL-PRT-Treated Platelets. Transfus Med Hemother. 2009; 36(2): 114–120.
  21. Klüter H, Bubel S, Kirchner H, et al. Febrile and allergic transfusion reactions after the transfusion of white cell-poor platelet preparations. Transfusion. 1999; 39(11-12): 1179–1184.
  22. Wang RR, Triulzi DJ, Qu L. Effects of prestorage vs poststorage leukoreduction on the rate of febrile nonhemolytic transfusion reactions to platelets. Am J Clin Pathol. 2012; 138(2): 255–259.
  23. Smoleńska –Sym G., Maślanka K.: Potransfuzyjna ostra niewydolność oddechowa. Journal of Transfusion Medicine. 2010; 3(3): 109–111.
  24. Peters AL, van Hezel ME, Juffermans NP, et al. Pathogenesis of non-antibody mediated transfusion-related acute lung injury from bench to bedside. Blood Rev. 2015; 29(1): 51–61.
  25. Maślanka K, Uhrynowska M, Łopacz P, et al. Analysis of leucocyte antibodies, cytokines, lysophospholipids and cell microparticles in blood components implicated in post-transfusion reactions with dyspnoea. Vox Sang. 2015; 108(1): 27–36.
  26. Fast LD, Marschner S, DiLeone G, et al. Functional inactivation of human white blood cells in whole blood products using the Mirasol system for whole blood. Transfusion 2008, 48 (S2): 169A–170A. (abstract no. SP363).
  27. Jackman RP, Heitman JW, Marschner S, et al. Understanding loss of donor white blood cell immunogenicity after pathogen reduction: mechanisms of action in ultraviolet illumination and riboflavin treatment. Transfusion. 2009; 49(12): 2686–2699.
  28. Apelseth TO, Hervig TA, Wentzel-Larsen T, et al. Cytokine accumulation in photochemically treated and gamma-irradiated platelet concentrates during storage. Transfusion. 2006; 46(5): 800–810.
  29. Reddy M, Eirikis E, Davis C, et al. Comparative analysis of lymphocyte activation marker expression and cytokine secretion profile in stimulated human peripheral blood mononuclear cell cultures: an in vitro model to monitor cellular immune function. J Immunol Methods. 2004; 293(1-2): 127–142.
  30. Fiebig E, Hirschkorn DF, Maino VC, et al. Assessment of donor T-cell function in cellular blood components by the CD69 induction assay: effects of storage, gamma radiation, and photochemical treatment. Transfusion. 2000; 40(7): 761–770.
  31. Hei DJ, Grass J, Lin L, et al. Elimination of cytokine production in stored platelet concentrate aliquots by photochemical treatment with psoralen plus ultraviolet A light. Transfusion. 1999; 39(3): 239–248.
  32. Muylle L, Peetermans ME. Effect of prestorage leukocyte removal on the cytokine levels in stored platelet concentrates. Vox Sang. 1994; 66(1): 14–17.
  33. Lachert E.: Metody inaktywacji biologicznych czynników chorobotwórczych w krwi i jej składnikach, Warszawa 2017, ISBN 978-83-947683-0-0.
  34. Gravemann U, Pohler P, Lambrecht B, et al. Inactivation of peripheral blood mononuclear cells by UVC light using the Theraflex UV-Platelet system. Transfus Med Hemother. 2008; 35(suppl1).
  35. Heddle NM, Klama L, Singer J, et al. The role of the plasma from platelet concentrates in transfusion reactions. N Engl J Med. 1994; 331(10): 625–628.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Czasopismo Journal of Transfusion Medicine dostęne jest również w Ikamed - księgarnia medyczna

Wydawcą serwisu jest Via Medica sp. z o.o. sp. komandytowa, ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl