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participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



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Leukocyte-Reduced Red Blood Cell Transfusions in Patients with Anemia and Human Immunodeficiency Virus Infection [Collier AC, et al. JAMA 2001;285:1592]: Anecdotal reports and small series have suggested that blood transfusions in patients with HIV infection may have an adverse effect on clinical course. As a result, about one-third of centers use leukoreduced blood products for HIV infection, and nearly 30% use irradiated blood [Transfusion 1995;35:612]. The present study is a randomized, double-blind comparative trial of leukoreduced RBC transfusions compared to unmodified RBC transfusions. The study involved a total of 531 persons with HIV and CMV who required transfusions for anemia in 11 U.S. centers from 1995 to 1999 with a median follow-up of 12 months. There were a total of 3,864 RBC units transfused. The results showed no difference in outcome by death or new opportunistic infection or frequency of transfusion reactions. Analysis of HIV viral load on days 7, 14, 21, and 28 showed no significant changes between the two groups. There were also no differences in CMV DNA, CD4 cell counts, or cytokine levels. The authors concluded that leukoreduction provided no clinical benefit.
Comment: The authors point out that leukoreduction of blood transfusions is a universal policy in many European countries and Canada, and this is proposed for the U.S. as well [Transfusion Med 1998;8:59]. The concern was based on preliminary studies suggesting HIV activation by transfusions. The authors have no good explanation for the lack of benefit from leukoreduction, but speculate that the low CD4 cell count (median of 15/mm3) may have blunted any immune response. The issues in this paper are substantial since it is estimated that 21 - 51% of HIV-infected patients are anemic, many require transfusions, and the cost of leukoreduction is $25 - $35 per unit. The results of this trial emphasize the need for large-scale studies in different populations before adopting policies that may be costly and unnecessary.
posted 4/13/2001





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