SESSION TYPE: ICU Infections
PRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PM
PURPOSE: Blood transfusion in ICU patients has been associated with increased risk of bacterial sepsis, transfusion-associated lung injury and mortality. This has been attributed to leucocytes in transfused blood. Objective: To compare leukocyte-depleted blood transfusion with conventional non-leukocyte depleted blood transfusion in patients with severe falciparum malaria.
METHODS: Outcome measures: Death from all cases at 28 days, incidence of ARDS and sepsis, severity of multiple organ dysfunction, and length of ICU stay in the two treatment groups. Patients: Sixty four consecutive ICU patients were studied over 16 months. All had severe falciparum malaria and required blood transfusion. Pregnant women and patients with previous blood transfusion were excluded. Intervention: Leukodepleted blood transfusion using bedside lekodepletion filter in “Filtered group”, versus regular non-lekodepleted blood transfusion in “Control group.”
RESULTS: Overall, 28-day mortality was similar in both groups (26.6% in filtered group vs 36.7% in the control group p=0.153). The incidence of ARDS was reduced in the filtered group (8.82% vs 26.67% in the control group; p=0.059). However, these were just short of statistically significance. Lekodepleted blood significantly reduced the occurrence of multiorgan dysfunction- mean Day-4 Sequetial Organ Failure Assessment(SOFA) score was 4.5 (SD 3.203) in the filtered group and 7.96 (SD 4.26) in the control group (p=0.002). Leukodepleted transfusions did not significantly reduce incidence of secondary bacterial sepsis (38.2% vs 53.3% in control group, p-0.226) or duration of ICU stay (mean 7.06, SD 3.38 vs mean 8.63, SD 4.32 in the control group, p=0.108).
CONCLUSIONS: Leukodepleted blood transfusion is possibly superior to a non-leukodepleted blood transfusion in severe falciparum malaria.In present study this benefit did not reach statistical significance because of the relatively small number of subjects studied.
CLINICAL IMPLICATIONS: A larger study with similar design tht will enroll 292 subjects is required to conclusively prove or disprove the benefits of lekodepleted transfusions.
DISCLOSURE: The following authors have nothing to disclose: Nagesh Waghmare, Nayan Desai, Dilip Karnad
No Product/Research Disclosure InformationKing Edward Memorial Hospital and Seth G. S. Medical College, Mumbai, India