• Joost A van Hilten, Leo M G van de Watering, J Hajo van Bockel, Cornelis J H van de Velde, Job Kievit, Ronald Brand, Wilbert B van den Hout, Robert H Geelkerken, Rudi M H Roumen, Ronald M J Wesselink, Ankie W M M Koopman-van Gemert, Jan Koning, and Anneke Brand.
• Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center and Sanquin Blood Supply, PO Box 9600, 2300 RC Leiden, Netherlands. J.A.van_Hilten@lumc.nl
• BMJ. 2004 May 29;328(7451):1281.

ObjectiveTo compare postoperative complications in patients undergoing major surgery who received non-filtered or filtered red blood cell transfusions.DesignProspective, randomised, double blinded trial.Setting19 hospitals throughout the Netherlands (three university; 10 clinical; six general).Participants1051 evaluable patients: 79 patients with ruptured aneurysm, 412 patients undergoing elective surgery for aneurysm, and 560 undergoing gastrointestinal surgery.InterventionsThe non-filtered products had the buffy coat removed and were plasma reduced. The filtered products had the buffy coat removed, were plasma reduced, and filtered before storage to remove leucocytes.Main Outcome MeasuresMortality and duration of stay in intensive care. Secondary end points were occurrence of multi-organ failure, infections, and length of hospital stay.ResultsNo significant differences were found in mortality (odds ratio for filtered v non-filtered 0.80, 95% confidence interval 0.53 to 1.21) and in mean stay in intensive care (- 0.4 day, - 1.6 to 0.6 day). In the filtered group the mean length of hospital stay was 2.4 days shorter (- 4.8 to 0.0 day; P = 0.050) and the incidence of multi-organ failure was 30% lower (odds ratio 0.70, 0.49 to 1.00; P = 0.050). There were no differences in rates of infection (0.98, 0.73 to 1.32).ConclusionThe use of filtered transfusions in some types of major surgery may reduce the length of hospital stay and the incidence of postoperative multi-organ failure.

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