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Open Access 
 

Leucodepletion in Thalassaemia Major Patients in Pakistan 
 

Kaenat Nasir 1, Usman Waheed 2, Saira Tahir 3, Hassan Abbas Zaheer 4 

Safe Blood Transfusion Programme, Ministry of National Health Services, Islamabad, Pakistan
 

Thalassaemia is a blood disorder in which an 

abnormal form of haemoglobin is made due to genetic 

aberration. Although no national database exists to 

calculate the exact number of thalassaemics, but it is 

estimated that there are 9.8 million carriers of the disease 

in Pakistan [1]. Consanguineous marriage is the leading 

cause for this high prevalence rate due to which the 

thalassaemia gene is trapped within the affected families. 

These patients are dependent on regular blood 

transfusions to sustain life in addition to expensive 

chelation therapy and other medical management. As a 

result, thalassaemia is a major healthcare challenge and 

places great psychological and financial trauma on the 

affected families and is a huge burden on the national 

healthcare delivery system [2].  

As the thalassaemia major patients are 

dependent on regular transfusions to sustain life [1], a 

common adverse effect of chronic transfusions in these 

patients is Febrile Non-Haemolytic Transfusion Reaction 

(FNHTR) with an occurrence rate of about 0.5-6.8% [3]. 

The FNHTRs occur due to immune reaction of the 

recipient against donor leucocytes [4]. Leucodepletion is a 

process of removing leucocytes from the donated blood 

either during blood collection, processing or at the 

bedside. The average amount of leucocytes present in 

donated human blood is estimated to be 109 per unit. 

According to the guidelines, the total amount of 

leucocytes present in a blood unit should be less than 5 x 

106 per unit after preparation  [5]. 

A pilot study was carried out in three major 

thalassaemia centres of Islamabad and Rawalpindi 

(Pakistan Institute of Medical Sciences Thalassaemia 

Centre; Pakistan Bait ul Mal Thalassaemia Centre; Jamila 

Sultana Thalassaemia Centre) on 120 thalassaemic 

patients with history of mild to moderate transfusion 

reactions. The study was conducted from January – April 

2018, and the ethical consent was given by the ethical 

review board of Pakistan Institute of Medical Sciences, 

Islamabad. Written consent was taken from patients (or 

their parents) before the start of transfusions and the 

results were analyzed using Microsoft Excel 2013. 

LeucoliteTM filters (by GLT Medical Co., Ltd.) were used 

during transfusion to the selected 120 patients. In the 

past, these patients were routinely given pre-medication 

[Solu-Cortef (100 Mg) and Avil Injections] to avoid 

transfusion reactions but with the leucofilter use, no pre-

medications was given to observe the effectiveness of the 

leucofilters. The age of transfused red cell concentrates 

ranged from 5-27 days. No transfusion reaction of any 

kind was observed in any of the patients using the 

leuofilters. 

 

A study conducted by Waheed et al., [6] on 

thalassaemia major cases, reported an incidence of 

26.3% transfusion associated reactions in a total of 2,193 

red cell transfusions, with FNHTR being the most 

common reaction. In the present study, reaction rate 

declined to 0%, when bedside filter was used and no 

FNTHRs were documented on cases which had earlier 

reported high incidence of FNTHRs. On the other hand, 

use of non leuco-reduced blood resulted in the 

occurrence of febrile non-haemolytic transfusion reactions 

with a reaction rate of 100%. This shows that a 

remarkable reduction occurs in FNTHRs when bedside 

filter leuco-reduced blood is transfused as compared to 

non-leucoreduced blood. Hence, leucoreduction of blood 

components in thalassaemic patients can be helpful in 

preventing transfusion reactions. Anecdotal evidence 

claims no effect on the rate of FNHTRs but that is 

invariably in those centres where the sub-standard filters 

are being used. The leucofilters sale thus needs to be 

regulated by the government. This is an on-going study, 

leucofilters will be used consistently on thalassaemics and 

other chronic recipients to assess the effectiveness of 

E D I T O R I A L  



 

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leucodepletion and co-relate it with financial impact 

including prolonging duration of interval of transfusion. 

R e f e r e n c e s  

1. Ahmed S, Saleem M, Modell B, Petrou M. Screening 

Extended Families for Genetic Hemoglobin Disorders in 

Pakistan. N Engl J Med. 2002;10;347(15):1162–8.  

2. Zaheer HA, Waheed U. Development of a national 

thalassemia policy in Pakistan. Glob J Transfus Med. 

2017;2:69-70. 

3. Perrotta PL, Snyder EL. Non-infectious complications of 

transfusion therapy. Blood Rev. 2001;15(2):69– 

83.  

 

4. Menis M, Forshee RA, Anderson SA, McKean S, Gondalia 

R, Warnock R, et al. Febrile non-haemolytic transfusion 

reaction occurrence and potential risk factors among the 

U.S. elderly transfused in the inpatient setting, as recorded 

in Medicare databases during 2011-2012. Vox 

Sang. 2015;108(3):251-61.   

5. Brecher ME. American Association of Blood Banks. 

Technical Manual. Bethesda, Md.: American Association 

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6. Waheed U, Wazeer A, Qasim Z, Iqbal Z, Zaheer HA. 

Surveillance of Adverse Transfusion Reactions in Multi- 

transfused Thalassaemia Patients in Mirpur, Azad Jammu 

and Kashmir, Pakistan. 2016; 12(1):27-30