Leukodepletion blood filters: filter design and mechanisms of leukocyte removal

Abstract

Modern leukocyte removal filters have been developed after years of refinement in design. Current filters are composite filters in which synthetic microfiber material is prepared as a nonwoven web. The filter material may be surface modified to alter surface tension or charge to improve performance. The housing design promotes effective contact of blood with the filter material and decreases shear forces. The exact mechanisms by which these filters remove leukocytes from blood components are uncertain, but likely represent a combination of both physical and biological processes whose contributions to leukocyte removal are interdependent. Small-pore microfiber webs result in barrier phenomena that permit retention of individual cells and increase the total adsorptive area of the filter. Modifications in surface charge can increase or decrease cell attraction to the fibers. Optimum interfacial surface tensions between blood cells, plasma, and filter fibers not only permit effective blood flow through small fiber pores, but also facilitate cell contact with the material. Barrier retention is a common mechanism for all modern leukocyte-removal filters and applies to all leukocyte subtypes. Because barrier retention does not depend on cell viability, it is operative for cells of any age and will retain any nondeformable cell, including whole nuclei from lymphocytes or monocytes. Barrier retention is supplemented by retention by adhesion. RBCs, lymphocytes, monocytes, granulocytes, and platelets differ in their relative adhesiveness to filter fibers. Different adhesive mechanisms are used in filters designed for RBCs compared with filters designed for platelets. Although lymphocytes, monocytes, and granulocytes can adhere directly to filter fibers, the biological mechanisms underlying cell adhesion may differ for these cell types. These differences may depend on expression of cell adhesion molecules. In the case of filtration of fresh RBCs, platelet-leukocyte interaction seems to supplement other mechanisms of leukocyte retention. The interactions of cells with biomaterials is an area of important research for implantable medical devices, artificial organs, and orthopedic, vascular, and dental prosthetics. Research in these areas is likely to contribute to improved biomaterials for blood filters. Improved techniques for the preparation of hybrid polymers and new techniques for surface modification of existing polymers will increase the technical opportunities for the development of synthetic surfaces ideally designed for leukocyte removal. It is therefore likely that the performance of leukocyte-removal filters will continue to improve. The development of cost-effective leukocyte removal filters specifically designed for use during component preparation would permit leukocyte depletion of all cellular blood components.