TME 64: Leucoreduction of Blood: Why Removing White Blood Cells Matters in Transfusions
- Dr. ARUN V J
- May 7
- 2 min read
Introduction
Blood transfusions save millions of lives every year, but not all components of donated blood are beneficial to every patient. One such component—white blood cells (leucocytes)—can sometimes cause more harm than good. This is where leucoreduction comes in.
What Are Leucocytes (White Blood Cells) in blood?
Leucocytes are the body’s defense soldiers. They play a critical role in:
Fighting infections (bacteria, viruses, fungi)
Removing dead or damaged cells
Regulating immune responses
However, while they’re essential inside our bodies, they aren’t always helpful when transferred into someone else’s bloodstream.
Why Are Leucocytes a Problem in Packed Red Blood Cell (PRBC) Transfusions?
When you donate blood, it’s separated into components like red cells, plasma, and platelets. Packed Red Blood Cells (PRBCs) are primarily used to treat anemia or blood loss.
But PRBCs still contain some leucocytes, which can cause complications such as:
1. Febrile Non-Hemolytic Transfusion Reactions (FNHTR)
Symptoms: Fever, chills, discomfort
Cause: Recipient’s immune system reacts to donor leucocytes
2. Alloimmunization (Immune System Sensitization)
Donor leucocytes can trigger antibody production in the recipient, making future transfusions or organ transplants riskier.
3. Transmission of Certain Infections
Some viruses (like CMV—Cytomegalovirus) hide inside white blood cells. Removing leucocytes reduces infection risk.
4. Immunomodulation (Weakening the Recipient’s Immunity)
Studies suggest leucocytes in transfusions may suppress the recipient’s immune system, increasing infection risks post-transfusion.
How Do We Remove Leucocytes on blood? (The Leucoreduction Process)
Leucoreduction is the filtration or centrifugation of blood to remove white blood cells. There are two main methods:
1. Pre-Storage Leucoreduction
Blood is filtered soon after donation, before storage.
More effective at preventing complications.
2. Bedside (Post-Storage) Filtration
Blood is filtered just before transfusion.
Less preferred because some harmful substances may already have formed.
Modern blood banks typically use pre-storage leucoreduction, ensuring safer blood right from storage.
Who Needs Leucoreduced Blood?
Not every patient requires leucocyte-free blood, but it’s critical for:
1. Cancer Patients (Especially Leukemia & Lymphoma)
Their immune systems are already weakened; extra leucocytes can cause severe reactions.
2. Organ Transplant Recipients
Reduces the risk of rejection by minimizing immune triggers.
3. Patients with Chronic Transfusion Needs (e.g., Thalassemia, Sickle Cell Disease)
Frequent transfusions increase the risk of alloimmunization—leucoreduction helps prevent this.
4. Neonates & Premature Babies
Their immature immune systems are highly sensitive to foreign leucocytes.
5. CMV-Negative Patients (When CMV-Safe Blood Isn’t Available)
Leucoreduction reduces CMV transmission risk.
Philosophical & Ethical Consideration: The Balance of Nature & Medicine
Blood is a natural life-sustaining fluid, yet medicine often refines it for safety—much like how we refine water to remove impurities.
This raises an interesting question: How much should we alter nature to protect human life?
In transfusion medicine, the answer is clear: removing harmful elements (like excess leucocytes) aligns with the Hippocratic principle of "do no harm."
Just as we filter toxins from water, we filter risks from blood—enhancing its life-giving properties.
Conclusion
Leucoreduction is a vital but often unseen step in transfusion medicine. By removing white blood cells, we prevent complications, protect vulnerable patients, and make transfusions safer.
Whether you’re a patient, donor, or simply curious about medical science, understanding this process highlights how modern medicine continuously evolves to save lives—one filtered drop at a time.
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