Effectiveness of Triple Saline Washed Leucoreduced Red Cells in Prevention of Post Transfusion Reaction Among Beta- Thalassemia Major Patients

Abstract

Introduction:
Beta-thalassemia major is an inherited hematological disorder characterized by severe anemia, necessitating lifelong regular blood transfusions. Although essential, repeated transfusions are associated with several complications such as febrile non-hemolytic transfusion reactions (FNHTRs), alloimmunization, allergic responses, and iron overload. Triple saline washing, a leukoreduction technique applied to packed red blood cells (PRBCs), significantly decreases residual leukocytes, thereby reducing transfusion-related adverse reactions. This study evaluates the effectiveness of triple saline–washed leukoreduced PRBCs in minimizing post-transfusion complications and enhancing transfusion safety in patients with beta-thalassemia major.

Objective:
To evaluate the efficacy of triple saline–washed leukoreduced PRBCs in reducing post-transfusion reactions and to analyze the association between the degree of leukoreduction and clinical outcomes.

Methods:
A cross-sectional study was conducted at a tertiary care center from January 2023 to October 2024. Patients diagnosed with transfusion-dependent beta-thalassemia major were enrolled. Inclusion criteria comprised confirmed diagnosis and regular transfusion requirements. Leukocyte counts were assessed before and after triple saline washing, and post-transfusion reactions were documented. Statistical analysis compared the frequency of transfusion reactions across different levels of leukoreduction.

Results:
Among the study participants, 68.6% achieved leukoreduction levels below 85%, while 31.4% exceeded this threshold. Patients with higher leukoreduction (>85%) experienced significantly fewer transfusion reactions (6.3%) compared to those with lower leukoreduction rates (40.0%) (p = 0.014). FNHTRs were the most frequently observed reactions (53.3%), followed by allergic reactions (40.0%). Most patients had pre-transfusion hemoglobin levels ranging from 8.5 to 9 g/dL (39.2%), consistent with recommended guidelines. The O-positive blood group was the most common (37.3%), and 98.82% of transfusions were completed without adverse events.

Conclusion:
Triple saline washing of PRBCs is a highly effective method for reducing post-transfusion reactions in patients with beta-thalassemia major, particularly when leukoreduction exceeds 85%. This technique offers a cost-effective, practical approach to improving transfusion safety, especially in resource-limited settings, and merits further investigation to assess long-term outcomes.