Preparation and storage features
To isolate leukocyte concentrate from whole blood, physical medium separation methods are used. In clinical practice, the main preparation methods are sedimentation techniques and automated centrifugation.
The finished medium is placed in specialized glass bottles or sealed plastic bags. Special attention should be paid to the temperature regime: the containers must be kept in refrigeration equipment at a strict temperature of 4–6 °C. The shelf life of this component is extremely short, lasting no more than 24 hours from the moment of preparation. For this reason, in emergency and elective surgery, it is considered most appropriate to transfuse exclusively freshly prepared concentrate to ensure maximum viability and functional activity of the transfused cells.
Leukocyte antigenic structure
The cell membrane of transfused leukocytes has a complex organization. It contains not only erythrocyte system antigens, but also specific antigenic complexes inherent exclusively to white blood cells. To date, science has discovered about 70 different leukocyte antigens. The most significant include the HLA (human leukocyte antigens) system, as well as the NA-NB systems and others.
Interestingly, the HLA system itself does not play a decisive role in routine transfusiology, but its significance increases colossally during organ and tissue transplantation surgeries. In these cases, exact antigen matching is critically important to prevent graft rejection.
Transfusion rules and donor selection
Transfusion of leukocyte-containing media requires strict adherence to safety protocols. Selecting a suitable donor for the recipient is a complex process. Compatibility must be considered across three key parameters:
- Matching for the AB0 system (blood group).
- Compatibility for the Rh factor (Rhesus factor).
- Matching for the HLA gene complex (used in strictly necessary cases, especially in immunized patients).
Regardless of the results of laboratory compatibility tests, immediately before starting the main infusion, performing a biological test is strictly mandatory.
Indications and potential complications
The main purpose of prescribing this medium is to replenish the deficiency of white blood cells. Absolute indications include:
- Pathological conditions and diseases accompanied by leukopenia (including neutropenia and pancytopenia).
- Agranulocytosis of various origins.
- Pronounced depression of hematopoiesis, which most often occurs as a consequence of aggressive radiation therapy or the use of cytostatics (chemotherapy).
- Severe infectious processes, in particular, sepsis.
Despite careful selection, transfusion may be accompanied by a number of adverse reactions. Characteristic clinical manifestations of complications include dyspnea, pronounced chills, and a sharp increase in body temperature. Cardiovascular manifestations may include tachycardia and a pathological drop in blood pressure (BP).
Briefly: answers to topical questions
What specific antigenic systems are present on the leukocyte cell membrane?
The leukocyte cell membrane contains erythrocyte systems, specific antigenic complexes, and CD antigens.
- HLA system — an antigenic complex important in organ and tissue transplantation.
- NA-NB system — one of the specific leukocyte antigenic systems.
- CD antigens (cluster of differentiation) — specific molecules (clusters of differentiation) that allow the identification of cell types and distinguish one leukocyte from another.
A total of about 70 antigens have been found on the leukocyte membrane.
What is the exact methodology and algorithm for performing a biological test before leukocyte concentrate transfusion?
The biological test before blood component transfusion is performed three times immediately before the start of the main transfusion. The execution algorithm:
- The product is administered by IV bolus.
- The transfusion is stopped for 3 minutes (during this time, a slow drip infusion is maintained to prevent needle thrombosis).
- The patient's condition is assessed (behavior, skin color, pulse, respiration).
- The procedure is repeated two more times.
In the absence of signs of incompatibility (tachycardia, dyspnea, facial flushing, drop in blood pressure), the main transfusion is initiated.
For quick memorization of the three main donor selection criteria, use the "A-Rh-HLA" rule: A — AB0 (group), Rh — Rhesus factor, HLA — gene complex.
Class and exam questions
Is it possible to transfuse leukocyte concentrate without performing a biological test?
No, this is strictly prohibited. Performing a biological test is a mandatory step before transfusion to exclude acute incompatibility reactions.
What is the importance of the HLA system in blood transfusion?
In standard transfusiology, the HLA system is usually not decisive. However, its consideration becomes absolutely necessary in organ and tissue transplantation, as well as in specific cases of leukocyte transfusion.
What is the maximum storage period for this component?
The medium is stored for no more than 24 hours at a temperature of 4–6 °C, after which the cells lose their viability. It is preferable to use freshly prepared concentrate.
What else to study on this topic
- Methodology for performing a biological test during transfusion
- Differential diagnosis of cytopenia types (leukopenia, pancytopenia, neutropenia)
- Pathophysiology of post-transfusion reactions (chills, drop in blood pressure)
- The role of the HLA system in transplantology and immunology
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