Abstract
Blood filters have been available since the 1930s. In this review we evaluate the role of microaggregate filters (MF) in certain transfusion complications, namely non-haemolytic febrile transfusion reactions (NHFTR), pulmonary injury, thrombocytopenia, fibronectin depletion and histamine release. We review the latest generation of leucocyte depleting filters and discuss their role in preventing alloimmunisation, immunosuppression and CMV transmission. Finally, we provide a rationale for the role of blood microfiltration in the present day practice of intensive care medicine.
Key words: Microaggregate blood filters, Microaggregates, Leucocyte-depleting filters
References
- 1.Eckert G. Prevention of pulmonary microembolism during blood transfusion by means of fine mesh filters. Anaesthesia. Intensivther Notfallmed. 1980;15:201–206. [PubMed] [Google Scholar]
- 2.Buley R, Lumley J. Some observations on blood microfilters. Ann Coll Surg Engl. 1975;57:262–267. [PMC free article] [PubMed] [Google Scholar]
- 3.Wenz B. Microaggregate blood filtration and the febrile transfusion reaction. Transfusion. 1983;23:95–98. doi: 10.1046/j.1537-2995.1983.23283172868.x. [DOI] [PubMed] [Google Scholar]
- 4.Wenz B. When is microfiltration of whole blood and red cell concentrate essential? When is it superfluous. Int Forum Vox Sang. 1986;50:63–64. doi: 10.1111/j.1423-0410.1986.tb04846.x. [DOI] [PubMed] [Google Scholar]
- 5.Lloyd GM, Marshall L. Blood microaggregates, their role in transfusion reactions. Intensive Care Worl. 1986;3:119–122. [Google Scholar]
- 6.Bolton DT, Peeters A. Microaggregates and filtration. Correspondence. Anaesthesia. 1988;43:330–331. doi: 10.1111/j.1365-2044.1988.tb08988.x. [DOI] [PubMed] [Google Scholar]
- 7.Derrington C. The present status of blood filtration. Anaesthesia. 1985;40:334–347. doi: 10.1111/j.1365-2044.1985.tb10786.x. [DOI] [PubMed] [Google Scholar]
- 8.Wright G. ACO and CPO blood preservation. Lancet. 1974;II:173. doi: 10.1016/s0140-6736(74)91613-4. [DOI] [PubMed] [Google Scholar]
- 9.Wright G (1975) The causes and effects of blood cell aggregates. International Symposium on the Fine Screen Filtration of Stored Blood, pp 21–32
- 10.Lowe GD. Filtration in IV therapy. A review of the clinical and technical aspects of intravenous fluid and blood filtration, in four parts. Part III: Clinical aspects of blood filtration. Br J IV Ther. 1981;2:28–38. [Google Scholar]
- 11.Robertson M, Boulton F, Doughty R, MacLennan JR, Collins A, McClelland DBL, Prowse CV. Macroaggregate formation in optimal additive red cells. Vox Sang. 1985;49:259–266. doi: 10.1111/j.1423-0410.1985.tb01120.x. [DOI] [PubMed] [Google Scholar]
- 12.Reul GJ, Beal AC, Greenberg S. Protection of the pulmonary vasculature by fine screen blood filtration. Chest. 1974;66:4–9. doi: 10.1378/chest.66.1.4. [DOI] [PubMed] [Google Scholar]
- 13.Reul GJ, Greenberg SD, Lefrak EA. Prevention of post traumatic pulmonary insufficiency fine screen filtration of blood. Arch Surg. 1973;106:386–394. doi: 10.1001/archsurg.1973.01350160008002. [DOI] [PubMed] [Google Scholar]
- 14.Wenz B, Gurtlinger KF, O'Toole AM, Dugan EP. Preparation of granulocyte poor red blood cells by microaggregate filtration: a simlified method to minimise future transfusion reactions. Vox Sang. 1980;39:282–287. doi: 10.1111/j.1423-0410.1980.tb01872.x. [DOI] [PubMed] [Google Scholar]
- 15.Perkins HA, Payne R, Ferguson J, Wood M. Non haemolytic febrile transfusion reactions. Quantitative effect of blood components with emphasis on isoantigenic incompatability of leucocytes. Vox Sang. 1966;11:578–600. doi: 10.1111/j.1423-0410.1966.tb04256.x. [DOI] [PubMed] [Google Scholar]
- 16.Mollison PL (1979) Blood transfusion in clinical medicine, 6th edn. Blackwell P, p 1033
- 17.Milner LV, Butcher K. Transfusion reactions reported after transfusion of red blood cells and of whole blood. Transfusion. 1978;18:493–495. doi: 10.1046/j.1537-2995.1978.18478251249.x. [DOI] [PubMed] [Google Scholar]
- 18.Parravicini A, Rebulla P, Apuzzo J, Wenz B, Sirchia G. The preparation of leucocyte poor red cells for transfusion by a simple cost effective techniques. Transfusion. 1984;24:508–509. doi: 10.1046/j.1537-2995.1984.24685066812.x. [DOI] [PubMed] [Google Scholar]
- 19.Meryman HT, Hornblower H. The preparation of red cells depleted of leucocytes. Review and evaluation. Transfusion. 1986;26:101–106. doi: 10.1046/j.1537-2995.1986.26186124010.x. [DOI] [PubMed] [Google Scholar]
- 20.Robb HJ, Mongulis RR, Jalo CM. Role of pulmonary microembolism in the haemodynamics of endotoxic shock? Surg Gynecol Obstet. 1972;135:777–783. [PubMed] [Google Scholar]
- 21.Davidson IJ, Barret A, Miller E, Litwin S. Pulmonary microembolisms associated with massive transfusion. Ann Surg. 1975;181:51–57. doi: 10.1097/00000658-197501000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Dhurandhur HN, Brown C, Barrett J, Litwin S. Pulmonary structural changes following microembolism and blood transfusions. Arch Pathol Lab Med. 1979;103:335–340. [PubMed] [Google Scholar]
- 23.Connell RS, Swank RL, Webb MC. Pulmonary microemboli after blood transfusions. An electron microscope study. Am Surg. 1973;177:40–50. [Google Scholar]
- 24.Miller RD, Robbins TO, Tang MJ, Barton SL. Coagulation effects associated with massive blood transfusion. Ann Surg. 1971;1474:794–801. doi: 10.1097/00000658-197111000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Monnucci PM, Federici AB, Sirchia A. Haemostasis testing during massive blood replacement. Vox Sang. 1982;42:113–132. doi: 10.1111/j.1423-0410.1982.tb01080.x. [DOI] [PubMed] [Google Scholar]
- 26.Lim S, Boughton BJ, Bareford D. Thrombocytopenia following routine blood transfusion: micro-aggregate blood filters prevent worsening thrombocytopenia in patients with low platelet counts. Vox Sang. 1989;56:40–41. doi: 10.1111/j.1423-0410.1989.tb03046.x. [DOI] [PubMed] [Google Scholar]
- 27.Bareford D, Chandler ST, Hawker RJ, Jackson N, Smith M, Boughton BJ. Splenic platelet sequestration following routine blood transfusion is reduced by filtered/washed blood products. Br J Haematol. 1987;67:177–180. doi: 10.1111/j.1365-2141.1987.tb02323.x. [DOI] [PubMed] [Google Scholar]
- 28.Hart S, Bareford D, Smith N, MacWhannel, Lanchbury E, Boughton B. Post-transfusion thrombocytopenia: its duration in splenic and asplenic individuals. Vox Sang. 1990;59:123–124. doi: 10.1111/j.1423-0410.1990.tb05024.x. [DOI] [PubMed] [Google Scholar]
- 29.Saba TM, Jaffe E. Plasma fibronectin (opsonic glycoprotein): its synthesis by vascular endothelial cells and role in cardiopulmonary integrity after trauma as related to reticuloendothelial function. Am J Med. 1980;68:577–594. doi: 10.1016/0002-9343(80)90310-1. [DOI] [PubMed] [Google Scholar]
- 30.Snyder EL, Mosher DF, Hezzey BA, Bock J, Golenwsky G (1980) Effect of blood transfusion on plasma fibronectin. Anaesthesiology 53 (Abstract S191) [PubMed]
- 31.Snyder EL, Mosher DF, Hezzey BA, Golenwsky G. Effects of blood transfusion on in vivo levels of plasma fibronectin. J Lab Clin Med. 1981;98:336–341. [PubMed] [Google Scholar]
- 32.Scovill WA, Saba TM, Blumenstock FA, Bernard H, Powers SR. Opsonic surface binding glycoprotein therapy during sepsis. Ann Surg. 1978;188:521–529. doi: 10.1097/00000658-197810000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Frewin DB, Jonsson JR, Head RJ, Russell WJ, Beal RW. Histamine levels in stored human blood. Transfusion. 1984;24:502–504. doi: 10.1046/j.1537-2995.1984.24685066810.x. [DOI] [PubMed] [Google Scholar]
- 34.Frewin DB, Jonsson JR, Davis KG, Beilby AM, Haylock DN, Beal RW, Russell WJ. Effect of microfiltration on the histamine levels in stored human blood. Vox Sang. 1987;52:191–194. doi: 10.1111/j.1423-0410.1987.tb03025.x. [DOI] [PubMed] [Google Scholar]
- 35.Dumbar RW, Price KA, Cannarella CF. Microaggregate blood filters: effect on filtration time, plasma haemaglobin and fresh blood platelet counts. Anaesth Analg. 1974;53:577–583. [PubMed] [Google Scholar]
- 36.Langhurst DM, Gooch WM, Castello RA. In vitro evaluation of a paediatric microaggregate blood filter. Transfusion. 1983;23:170–177. doi: 10.1046/j.1537-2995.1983.23283172861.x. [DOI] [PubMed] [Google Scholar]
- 37.Schmidt WF, Kim HC, Schwartz E, Tomassini N. RBC destruction caused by a micropore blood filter. J Am Med Assoc. 1982;248:1629–1632. [PubMed] [Google Scholar]
- 38.Linko GE. Microaggregate filters and neonate patients. Transfusion. 1983;23:537–548. doi: 10.1046/j.1537-2995.1983.23684074283.x. [DOI] [PubMed] [Google Scholar]
- 39.Snyder EL, Mezzey A, Cooper-Smith M, Mones R. Effects of microaggregate blood filtration on platelet concentrated in vitro. Transfusion. 1981;21:427–434. doi: 10.1046/j.1537-2995.1981.21481275999.x. [DOI] [PubMed] [Google Scholar]
- 40.Yellon RF, Vernick S, Golub AH. Complement activation by blood micro-filters. Transfusion. 1981;21:610–611. [Google Scholar]
- 41.Snyder El, Root RK, McLeod B, Dalmasso AP. Activation of complement by blood transfusion filters. Vox Sang. 1983;45:288–293. doi: 10.1111/j.1423-0410.1983.tb01916.x. [DOI] [PubMed] [Google Scholar]
- 42.Meryman HT. Transfusion induced alloimmunisation and immunosuppression and the effect of leucocyte depletion. Transfusion Med Rev. 1989;3:180–193. doi: 10.1016/s0887-7963(89)70078-x. [DOI] [PubMed] [Google Scholar]
- 43.Tartter PI. Blood transfusion and infectious complications following colorectal cancer surgery. Br J Surg. 1988;75:789–792. doi: 10.1002/bjs.1800750822. [DOI] [PubMed] [Google Scholar]
- 44.Verdonck LF, de Graan-Hentzen YCE, Dekker AW, Mudde GC, de Gast GC. Cytomegalovirus seronegative platelets and neukocyte-poor red blood cells from random donors can prevent primary cytomegalovirus infection after bone marrow transplantation. Bone Marrow Transplant. 1987;2:73–78. [PubMed] [Google Scholar]
- 45.de Graan Hentzen YCE, Gratama JW, Mudde GC, van Loon AM, Verdonck LF, Willemze R, Brand A, de Gast GC. Prevention of primary cytomegalovirus infection during induction treatment of acute leukemia using at random leucocyte poor blood products. Br J Haematol. 1987;66:421. [Google Scholar]
- 46.Murphy MF, Grant PCA, Hardiman AE, Lister TA, Waters AH. Use of leucocyte poor blood components to prevent cytomegalovirus (CMV) infections in patients with acute leukemia. Br J Haematol. 1988;20:253–255. doi: 10.1111/j.1365-2141.1988.tb02473.x. [DOI] [PubMed] [Google Scholar]
- 47.Gilbert G, Hayes K, Hodson IL, James J. Prevention of transfusion acquired cytomegalovirus infections in infants by blood filtration to remove leucocytes. Lancet. 1989;I:1228–1231. doi: 10.1016/s0140-6736(89)92330-1. [DOI] [PubMed] [Google Scholar]
- 48.de Graan Hentzen YCE, de Gast GC, Gratama JW, Brand A, Verdonck LF, Mudde GC (1989) Prevention of primary CMV infection by leukocyte depletion of blood products. 2nd International Cytomegalovirus Workshop, p 13
- 49.de Graan Hentzen YCE, Gratama JW, Mudde GC, Verdonck LF, Houbiers JGA, Brand A, Sebens FW, van Loon AM, The TH, Willemze R, de Gast GC. Prevention of primary cytomegalovirus infection in patients with haematologic malignancies by intensine white cell depletion of blood products. Transfusion. 1989;29:757–760. doi: 10.1046/j.1537-2995.1989.29990070177.x. [DOI] [PubMed] [Google Scholar]
- 50.Bowden RA, Sayers MH, Cays M (1989) The role of blood product filtration in the prevention of transfusion associated cytomegalovirus infection after marrow transplant. 42nd Annual Meeting AABB.
- 51.Eernisse JG, Brand A. Prevention of platelet refractoriness due to HLA antibodies by administration of leukocyte-poor blood components. Exp Haematol. 1981;9:77–81. [PubMed] [Google Scholar]
- 52.Schiffer CA, Dutcher JP, Aisner J, Hogge D, Wiernik PH, Reilly JP. A randomized trial of leukocyte-depleted platelet transfusions to modify alloimmunisation in patients with leukaemia. Blood. 1983;62:815–820. [PubMed] [Google Scholar]
- 53.Murphy MF, Metcalfe P, Thomas H. Use of leukocyte-poor blood components and HLA matched platelet donors to prevent alloimmunization. Br J Haematol. 1986;62:529–539. doi: 10.1111/j.1365-2141.1986.tb02965.x. [DOI] [PubMed] [Google Scholar]
- 54.Sniecinski I, O'Donnell NR, Nowicki B. Prevention of refractoriness and HLA alloimmunisation using filtered blood products. Blood. 1988;71:1402–1407. [PubMed] [Google Scholar]
- 55.Andreu G, Dewailly J, Leberre C, Quarre MC, Bidet ML, Tardivel R, Devers L, Lam Y, Soreall E, Boccaccio C, Piard N, Bidet JM, Genetet B, Faunchet Prevention of HLA immunization with leucocyte poor packed cells and platelet concentrates obtained by filtration. Blood. 1988;72:964–969. [PubMed] [Google Scholar]
- 56.Brand A, Claas FHJ, Voogt PJ, Wasser MNJM, Eernisse JG. Alloimmunisation after leukocyte depleted multiple random donor platelet transfusions. Vox Sang. 1988;54:160–166. doi: 10.1111/j.1423-0410.1988.tb03892.x. [DOI] [PubMed] [Google Scholar]
- 57.Myllyla G, Ruutu R, Oksanen V, Kekomaki R, Rasi V, (1986) 19th Congr Int Soc Blood Transfusion, Australia (Abstract)
- 58.Saarinen TM, Kekomaki R, Siimes M, Myllyla G. Effective prophylaxis against platelet refractoriness in multitransfused patients by use of leucocyte-free blood components. Blood. 1990;75:512–517. [PubMed] [Google Scholar]