In Reply: We agree with Dr Wallis that the
use of buffy coat–depleted RBCs before the policy was enacted might
have diluted our observed mortality effect of prestorage leukoreduction. However,
the 2 Canadian blood operators did not prepare buffy coat–depleted RBCs
at any point during this time. Routine depletion of the buffy coat is not
used in the preparation of blood components in North America. Some data, however,
suggest that prestorage leukoreduction confers an incremental benefit over
buffy-coat depleted RBCs.1,2 In
addition, animal studies provide evidence that depletion of the buffy coat
imparts a partial transfusion-associated immunomodulatory effect less than
that seen with prestorage leukoreduction.3 Thus,
prestorage leukoreduction appears to provide a greater clinical benefit than
either nonleukoreduced or buffy coat–depleted RBCs.
Fergusson D, Blajchman M, for the Leukoreduction Study Investigators. Leukoreduction vs Buffy-Coat Depletion and the Safety of Blood Transfusion—Reply. JAMA. 2003;290(12):1580. doi:10.1001/jama.290.12.1580-a
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