No abstract

Allogeneic blood transfusion (ABT) is associated with transfusion-related immune modulation (TRIM) and subsequent poorer patient outcomes including perioperative infection, multiple organ failure, and mortality. The precise mechanism(s) underlying TRIM remain largely unknown. During intraoperative cell salvage (ICS) a patient’s own (autologous) blood is collected, anticoagulated, processed, and reinfused. One impediment to understanding the influence of the immune system on transfusion-related adverse outcomes has been the inability to characterize immune profile changes induced by blood transfusion, including ICS. Dendritic cells and monocytes play a central role in regulation of immune responses, and dysfunction may contribute to adverse outcomes. During a prospective observational study ( n = 19), an in vitro model was used to assess dendritic cell and monocyte immune responses and the overall immune response following ABT or ICS exposure. Exposure to both ABT and ICS suppressed dendritic cell and monocyte function. This suppression was, however, significantly less marked following ICS. ICS presented an improved immune competence. This assessment of immune competence through the study of intracellular cytokine production, co-stimulatory and adhesion molecules expressed on dendritic cells and monocytes, and modulation of the overall leukocyte response may predict a reduction of adverse outcomes ( i.e., infection) following ICS.

ABO compatible allogeneic blood transfusion (ABT) is associated with transfusion-related immune modulation (TRIM) and poor patient outcomes including perioperative infection and myocardial infarction. Intraoperative cell salvage (ICS) enables collection, processing and reinfusion of autologous blood lost during surgery. We investigated whether immune suppression associated with ABT could be reduced by using ICS. Suitable orthopaedic patients were consented and recruited to the study (n=20, HREC/17/QRBW/685). 10mL anticoagulated blood (EDTA) was collected from the patient (pre-operatively) and from the ICS blood product. An established whole blood culture model was used to assess changes to monocyte and myeloid dendritic cell (mDC) inflammatory responses (intracellular cytokine staining for IL-6, IL-8, IL-10, IL-12, IL-1α, TNF-α, MIP-1α, MIP-1β, MCP-1, IP-10) following exposure of the patient’s pre-operative blood to ABO compatible allogenic blood (Blood Service, Kelvin Grove) or their ICS blood (P<0.05 ANOVA). Exposure to ABT significantly suppressed the inflammatory response of both mDC (IL-10, IL-12, IL-1α, IL-8, TNF-a, MIP-α, MIP-1β) and monocytes (IL-10, IL-6, IL-12, IL-1α, IL-8, IL-10, IL-12, TNF-α and MIP-1α). Compared to ABT, exposure to the patients’ own (ICS) blood improved mDC IL-8, IL-10, IL-12, TNF-α and MIP-1α production and monocyte IL-10 and MIP-1β production. We provide in vitro evidence that ICS may reduce ABT associated adverse outcomes associated with improved inflammatory response and immune competence post-transfusion.

No abstract

Recent clinical and epidemiological studies worldwide suggest an increasing incidence of male factor infertility (MFI). Paucity of information on the biochemical analysis of seminal fluid in Sri Lanka prompted undertaking a pilot study to establish a clinical marker for the male fertility status in Sri Lanka based on the level of the cytokine, macrophage migration inhibitory factor (MIF) in seminal fluid, an area hitherto unexplored locally. The analysis was carried out on the semen samples of infertile males (N = 61) where age matched individuals (N = 30) with proven past paternity served as controls. D-dopachrome tautomerase assay was performed to assess the MIF level in semen while other seminal fluid parameters were assessed according to the standard WHO criteria. The present study revealed an abnormal biphasic profile of MIF in the seminal fluid of individuals with impaired sperm parameters, which was either significantly below or above the range of MIF tautomarase activity typical of normal fertile men (p < 0.000). This is the first report in a Sri Lankan population. The receiver operating characteristic (ROC) plot analysis established a cutoff point of 3.375 µg MIF/mL of semen (at 90 % sensitivity: 81.2 % specificity; 0.923 accuracy) to differentiate fertile from infertile males (excluding azoospermics and severe oligozoospermics). The MIF concentrations significantly correlated with the semen pH in the azoospermic and severe oligozoospermic group. As MIF was clearly indicative of the male fertility status by estimates of sensitivity and specificity of the D-dopachrome tautomerase assay, MIF may be developed as a potential marker of male infertility in Sri Lanka.