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Nationwide Outbreak of Red Eye Syndrome Associated With Transfusion of Leukocyte-Reduced Red Blood Cell Units

Published online by Cambridge University Press:  21 June 2016

Juan Alonso-Echanove
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia Epidemic Intelligence Service, Epidemiology Program Office, Emory University School of Medicine, Atlanta, Georgia Aveta, Fort Lee, New Jersey
Brian D. Sippy
Affiliation:
Centers for Disease Control and Prevention, and the Emory University School of Medicine, Atlanta, Georgia Montana Neuroscience Institute Foundation, Missoula, Montana
Arthur E. Chin
Affiliation:
Epidemic Intelligence Service, Epidemiology Program Office, Emory University School of Medicine, Atlanta, Georgia Office of Disease Prevention and Epidemiology, Oregon Department of Human Services, Portland, Oregon Sharon Hospital Emergency Department, Sharon, Connecticut
Lisa Cairns
Affiliation:
Epidemic Intelligence Service, Epidemiology Program Office, Emory University School of Medicine, Atlanta, Georgia Washington State Department of Health, Olympia, Washington National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia
Rebecca Haley
Affiliation:
American Red Cross, Washington, D.C. Aldagen, Durham, North Carolina
Jay S. Epstein
Affiliation:
Center for Biological Evaluation and Research, Food and Drug Administration, Washington, D.C.
Michael J. Richards
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia Victorian Infectious Diseases Service, Royal Melbourne Hospital, Victoria, Australia
Henry Edelhauser
Affiliation:
Centers for Disease Control and Prevention, and the Emory University School of Medicine, Atlanta, Georgia
Katrina Hedberg
Affiliation:
Office of Disease Prevention and Epidemiology, Oregon Department of Human Services, Portland, Oregon
Matthew J. Kuehnert
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
William R. Jarvis
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
Michele L. Pearson
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
Corresponding
E-mail address:

Abstract

Objective.

To characterize red eye reactions occurring within 24 hours after receipt of units of leukocyte-reduced red blood cells, determine their etiology, and investigate their potential link to transfusion.

Methods.

We conducted a survey of transfusion facilities nationwide to determine the scope and magnitude of the reactions; performed case-control and cohort studies among transfused patients at the facility where most reactions occurred; and performed animal experiments, using cellulose acetate derivatives extracted from leukocyte-reduction filters and filter precursors, to reproduce reactions.

Results.

From January 1, 1997, through January 15, 1998, we identified 159 reactions in 117 patients from 17 states. Reactions were characterized by conjunctival erythema or hemorrhage (in 100% of patients), eye pain (in 62%), photophobia (in 46%), and decreased visual acuity (in 32%). Symptom onset occurred 1-24 hours after initiation of transfusion and resolved within a median of 5 days. Reactions were associated with transfusion sessions that included units of red blood cells filtered with a specific brand of filter, the LeukoNet filter (HemaSure) (odds ratio, 100.4; P< .001). There was a dose-response relationship between the number of LeukoNet-filtered units transfused and the attack rate for reactions, ranging from 0.8% among sessions in which 1 unit was transfused to 27.3% among sessions in which 3 or more units were transfused (P< .001). A similar ocular syndrome was elicited in rabbits injected with cellulose acetate derivatives extracted from unused LeukoNet filters or filter precursors. No reactions were reported after LeukoNet filters were withdrawn from the market.

Conclusions.

This transfusion-associated red eye syndrome was linked to a specific brand of leukocyte-reduction filter and likely resulted from cellulose acetate derivatives leached from the filter membrane.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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