As of September 1999, all donated units of blood in Canada undergo a process known as pre-storage leukoreduction. This process removes a significant proportion of white blood cells from blood at the time of donation. The decision to implement universal leukoreduction was based on fairly strong evidence that leukoreduction was beneficial in some adult populations such as cardiac and colorectal surgical patients. However, very little information exists on its effectiveness in other populations such as the neonatal population. The purpose of this thesis was three fold: (1) to conduct a systematic review of the literature to assess the effectiveness of leukoreduction; (2) to undertake a methods paper outlining the optimal design to study the effectiveness of leukoreduction given its universal nature; and (3) to conduct a study assessing the effectiveness of leukoreduction in the neonatal population. / The results of the systematic review elucidate the paucity of well-conducted, methodologically sound studies evaluating the effectiveness of leukoreduction in the neonatal population. The current evidence suggests that leukoreduction may be effective. However, further studies are needed especially with respect to clinically important outcomes. The lack of convincing data and the significant cost of leukoreduction mandate evaluations to determine its clinical and economic impact. / The methods manuscript describes important methodological issues confronted in the design of the before/after evaluation. Because of the universal application of many transfusion interventions, one has to consider, carefully, the methodological rigor with which these interventions are evaluated. The methodological considerations discussed are: (1) threats to internal validity; (2) precision; and (3) generalizability. Properly conceived, designed, conducted, and analyzed, such a before/after study design can yield informative associations. / The final paper presents the results of the before/after study. The study included a total of 515 infants <1250 grams from three sites across Canada. The effect of leukoreduction on our primary outcome of nosocomial bacteremia was an odds ratio of 0.59 (95%CI: 0.34--1.01). Crude and adjusted rates for all major neonatal morbidities suggest that leukoreduction improved all outcomes. The adjusted odds ratio for a composite measure of any major neonatal morbidity was 0.31 (95%CI: 0.17--.56). Based on the results of this study, it is concluded that the implementation of universal prestorage leukoreduction significantly improved clinical outcomes in premature infants requiring blood transfusions.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:QMM.82868 |
| Date | January 2002 |
| Creators | Fergusson, Dean Anthony |
| Contributors | Shapiro, Stan (advisor), Hebert, Paul C. (advisor) |
| Publisher | McGill University |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Format | application/pdf |
| Coverage | Doctor of Philosophy (Department of Epidemiology and Biostatistics.) |
| Rights | All items in eScholarship@McGill are protected by copyright with all rights reserved unless otherwise indicated. |
| Relation | alephsysno: 001975313, proquestno: AAINQ88463, Theses scanned by UMI/ProQuest. |
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