背景:已使用白细胞减少来限制不良事件的风险。最常用的方法是过滤(储存前或储存后)。然而,储存前过滤是否优于储存后过滤需要明确定义,特别是对于仍然使用储存后过滤的国家。本研究旨在综合关于储存前过滤器与储存后过滤器对输血反应的有效性的最佳可用证据。对于感染的发生,住院时间长短,以及接受白细胞减少输血的患者的死亡。
方法:我们搜索了MEDLINE(PubMed),CINAHL(EBSCO),PsycINFO(APA),Scopus(Elsevier),Cochrane图书馆(J.Wiley),WebofScience核心合集(ClarivateAnalytics),Embase(Elsevier),2020年8月和LILACS(VHL)数据库和灰色文献,用于符合条件的研究,并于2023年10月更新了搜索。JoannaBriggs研究所的关键评估工具被用来分析研究的质量评估。等级用于确定证据的确定性。
结果:荟萃分析显示,储存前过滤是红细胞发热性非溶血性输血反应(RR0.49,95%CI0.41-0.59)和血小板浓缩输血(RR0.16,95%CI0.12-0.22)发生的保护因素。血小板浓缩输血后的术后感染没有发生相同的情况(RR0.82,95%CI0.65-1.04)。只有一项研究分析了住院时间,根据使用的过滤器类型,接受白细胞减少输血的患者之间没有显着差异。根据等级标准,发热性非溶血性输血反应的证据的确定性对于红细胞较低,对于血小板浓缩物较低,因为偏倚风险较高.由于不精确,感染的风险很低。
结论:本综述的结果表明,为所分析的结果推荐最佳类型的过滤器(储存前或储存后)的确定性仍然很脆弱;因此,需要更有力的证据。
背景:PROSPEROCRD42020192202.
BACKGROUND: Leukoreduction has been used to limit the risk of adverse events. The most commonly used methodology is filtration (pre- or post-storage). However, whether pre-storage filtration is better than post-storage filtration needs to be clearly defined, particularly for countries that still use post-storage filtration. This study aimed to synthesize the best available evidence on the effectiveness of pre-storage filters compared with post-storage filters for transfusion reactions, for the occurrence of infections, for the length of hospital stay, and for the death of patients undergoing leukoreduced transfusion.
METHODS: We searched the MEDLINE (PubMed), CINAHL (EBSCO), PsycINFO (APA), Scopus (Elsevier), The Cochrane Library (J. Wiley), Web of Science Core Collection (Clarivate Analytics), Embase (Elsevier), and LILACS (VHL) databases and gray literature for eligible studies in August 2020 and updated the search in October 2023. The Joanna Briggs Institute critical assessment tools were applied to analyze the quality appraisal of the studies. GRADE was used to determine the certainty of the evidence.
RESULTS: The meta-analysis showed that pre-storage filtration was a protective factor for the occurrence of febrile non-hemolytic transfusion reaction in red blood cells (RR 0.49, 95% CI 0.41-0.59) and platelet concentrate transfusions (RR 0.16, 95% CI 0.12-0.22). The same did not occur for post-surgical infection after platelet concentrate transfusions (RR 0.82, 95% CI 0.65-1.04). Only one study analyzed the length of hospital stay and showed no significant difference between patients who received leukoreduced transfusions according to the type of filter used. According to the GRADE criteria, the certainty of the evidence for febrile non-hemolytic transfusion reactions was low for red blood cells and very low for platelet concentrate due to the high risk of bias. Infection was a low risk due to imprecision.
CONCLUSIONS: The results of this review showed that the certainty of recommending the best type of filter (pre- or post-storage) for the benefit of the outcomes analyzed is still fragile; therefore, more robust evidence is needed.
BACKGROUND: PROSPERO CRD42020192202.