In several studies, prestorage leukoreduction decreased RBC storage lesions, with fewer immunomodulating properties [68] and less adhesion of stored RBCs to the endothelium [69] . A clinical benefit of leukoreduction is still somewhat controversial, particularly in the critically ill patient where no randomized, controlled trial has been performed [70] . In a before-after study of 14,786 patients who underwent cardiac surgery, repair of hip fracture, or who required intensive care after surgery, there was a 1% decrease in mortality rate associated with the implementation of universal leukoreduction [71] . In a recent meta-analysis of nine RCTs involving 3,093 surgical patients, the use of leukoreduction significantly reduced the odds of postoperative infection (summary OR, 0.522; 95% CI, 0.332-0.821; p = 0.005) [72] . This observation had been suggested in a previous meta-analysis [73] but has been challenged by another recent meta-analysis [74] . Nevertheless, leukoreduction makes sense, and many countries have adopted it as routine, even though costs are elevated. In Europe, at the time of the SOAP study in 2002, 76% of centers reported using leukodepleted blood routinely [34] , whereas an earlier study performed in the same countries reported lower rates [3] .