Regional implementation, guideline landscape, and economic impact of blood component leukoreduction: a systematic literature review

Abstract

Background - Blood component leukoreduction reduces transfusion reactions, but its worldwide implementation is heterogeneous, largely due to economic barriers. This systematic review aimed to synthesize the available evidence on the implementation of leukoreduction, related policies and guidelines, and its economic impact.

Materials and methods - We searched Ovid® MEDLINE and Embase for studies published between 2015 and 2025. Eligible studies evaluated (1) the implementation of leukoreduction across countries, (2) policies and recommendations, and (3) its impact on healthcare costs and resource utilization. Titles and abstracts were screened by two reviewers, and key findings were gathered in a predefined data extraction form.

Results - A total of 38 studies were included from 1,623 screened records. Regional implementation of leukoreduction varied widely. Some countries, such as the United States, reached a near-universal implementation of leukoreduction over the study period, whereas limited data from the Asia-Pacific, Middle East, and African regions suggested low leukoreduction implementation. In Europe, national estimates were heterogeneous, although increasing trends were observed in some countries. Guidelines recommend leukoreduction to prevent febrile non-hemolytic transfusion reactions, HLA alloimmunization, and transfusion-transmitted infections, with some recommending its use for specific patient subgroups. Few studies assessed the incremental cost of leukoreduction, with one study from Uganda estimating an additional cost of USD 37 per unit. Some studies reported shorter durations of mechanical ventilation and reduced lengths of hospital stay among recipients of leukoreduced components.

Discussion - Over the past decade, published studies on leukoreduction implementation have remained sparse, and the available literature indicates that the field has advanced little in many regions. Implementation remains heterogeneous globally, and robust evidence on its economic impact is still limited, underscoring the need for further cost-effectiveness studies.