The purpose of this study is to determine if leukoreduced blood transfusions reduce the risk
of infection following trauma. Specifically, the investigators intend to evaluate whether
there are clinically relevant differences in the rates of infection and in the severity of
multiple organ failure in critically injured trauma patients receiving leukoreduced blood
products compared to those receiving standard allogeneic blood products.
Many severely injured patients survive their initial resuscitation only to suffer the late
sequelae of nosocomial infection and multiple organ failure. The depth of hemorrhagic shock
and the severity of anatomic injury are clearly associated with these adverse outcomes,
however there is clear evidence to suggest that events during the resuscitation phase also
play an important role in the pathogenesis of these sequelae. Specifically, there is now
substantial clinical and experimental evidence implicating blood transfusion and the
transfusion of allogeneic passenger leukocytes in the immune dysregulation characteristic of
the post-injury state. This immune dysregulation manifests on two fronts: an uncontrolled
inflammatory response leading to organ dysfunction and a state of immunoparalysis, leading
to the development of nosocomial infection. Allogeneic passenger leukocytes have been
implicated in the alterations in non-specific and specific immunity that underlie this state
of altered immunoresponsiveness. The importance of allogeneic leukocytes in these phenomena
suggests that strategies designed to limit the exposure of patients to these cells may
reduce the incidence of post-injury sequelae. Pre-storage leukoreduction, whereby donated
blood is passed through a leukocyte filter prior to storage and ultimate transfusion is one
such strategy. This strategy remains at the center of a national debate on a policy of
universal leukoreduction in which its efficacy is unproven and its cost undisputed.
- To evaluate whether there are clinically relevant differences in the rates of infection
and in the severity of multiple organ failure in critically injured trauma patients
receiving leukoreduced blood products compared to those receiving standard allogeneic
- To assess T-cell responsiveness and the dominant CD4 lymphocyte subset as measured by
T-lymphocyte IL-2 receptor expression and cytokine profile, respectively, in critically
injured subjects transfused with leukoreduced blood products compared to subjects
receiving standard allogeneic blood products.
- To assess the activational state of the peripheral blood monocyte and the neutrophil in
critically injured trauma patients receiving leukoreduced blood products compared to
subjects receiving standard allogeneic blood products.
- To evaluate whether there are clinically relevant differences in rates of acute lung
injury (ALI) and circulating markers of ALI in patients receiving leukoreduced versus
standard allogeneic blood products.
- To evaluate rates of microchimerism in those receiving leukoreduced versus standard
- Trauma patients
- Age > 17
- Transfusion within 24 hours of injury
- Active infection at time of injury
- Anticipated survival of < 48 hours (e.g. gunshot wound [GSW] to head, cardiopulmonary
resuscitation [CPR] in progress)
- Receipt of blood products for this injury event prior to randomization
- AB negative; B negative blood type.
- Positive antibody screen
- Prior requirement for irradiated, leukoreduced or cytomegalovirus (CMV) seronegative
- Enrolled in pre-hospital trial