Allogeneic leukocytes in cardiac surgery: Good or bad?

Abstract

Worldwide, cardiac surgery is a common procedure requiring a large quantity of allogeneic blood products, which are associated with postoperative complications. Leukocytes present in blood products may play a role in these complications, which are referred to as transfusion-related immunomodulation (TRIM). Several randomized controlled trials (RCTs) in different settings investigated the effects of allogeneic leukocytes in red blood cells (RBCs). Cardiac surgery studies reported a reduction in postoperative infections and mortality in patients that received leukocyte-reduced RBCs compared with leukocyte-containing RBCs; this was mainly due to more deaths due to infections and multiple organ dysfunction syndrome (MODS) in the group that received leukocyte-containing RBCs. Patients with postoperative complications had higher concentrations of inflammatory mediators. These findings suggest that leukocytecontaining transfusion during cardiac surgery induces a second insult to the systemic inflammatory response. In the present review we discuss the possible role of blood transfusions in cardiac surgery. Especially, we focus on the possible role of allogeneic leukocytes associated with postoperative complications after cardiac surgery. (Turk J Hematol 2011; 28: 160-9) Key words: Blood transfusions, transfusion-related immunomodulation, leukodepletion, infections, mortality, cardiac surgery (Turk J Hematol 2011; 28: 160-9) Anahtar kelimeler: Kan transfüzyonları, transfüzyon ile ilişkili immünomodülasyon, lökodeplesyon, enfeksiyonlar, mortalite, kardiyak cerrahisi

Serum BPI as a novel biomarker in asthma

“…Activated neutrophils secrete a variety of cytokines, including IL-1, IL-6, TNFalpha and PAF, which are associated with sustained airway injury, airway smooth muscle thickening and airway remodeling [17]. Previous studies reported BPI as a key marker of neutrophil activation [18,19]; therefore, we hypothesized that the increase in BPI levels is associated with asthma.…”

Effect of leukoreduction on transfusion‐related immunomodulation in patients undergoing cardiac surgery

“…It is quite difficult to remove all confounding factors to evaluate the independent effect of leukoreduction on LOS. 26 This was probably the reason for controversial results in previous studies. [16][17][18]20,22,27 Moreover, these studies were conducted more than a decade ago, so we can presume an overall improvement in the health care system playing a major role in reducing infection.…”

“…The LOS of a patient in the ICU or in the hospital depends on various factors like comorbidity of the patient, length of surgery, duration of anaesthesia, use of drugs and postoperative infections. It is quite difficult to remove all confounding factors to evaluate the independent effect of leukoreduction on LOS 26 . This was probably the reason for controversial results in previous studies 16‐18,20,22,27 .…”

A multivariate analysis to assess the effect of packed red cell transfusion and the unit age of transfused red cells on postoperative complications in patients undergoing cardiac surgeries

“…Worldwide approximately 1,000,000 patients undergo cardiac surgery annually. [ 13 ] Although several blood conservation strategies are now being employed, allogenic blood transfusions play a crucial role in these advanced surgical procedures. Patients undergoing cardiac surgeries consume a large proportion of RBC units, estimated at approximately 20% of the total blood supply.…”