Blood transfusion‐related immunomodulation in patients with major obstetric haemorrhage

Abstract

Background Blood transfusion is suggested to be immunosuppressive in surgical patients. However, the immunomodulatory effect of blood transfusion in obstetric patients with massive haemorrhage remains unknown.Methods Three hundred and fifty-five patients at active labour in the obstetric department were enrolled, and clinical characteristics were extracted from electrical medical records, inpatient notes, anaesthesia notes and discharge summaries. The transfused blood products included RBC, FFP and PLTs. RT-PCR was used to quantify gene expression in the blood samples, and the Spearman rank correlation coefficient was used to test correlation.Results Among the 355 patients, 138 received a diagnosis of obstetric haemorrhage and were treated with blood transfusion. The risk factors for blood transfusion included maternal age, gestational age, preterm labour and instrumental delivery. The infants delivered by the transfusion group had significantly lower birthweight and 1-and 5-min Apgar scores. Most importantly, blood transfusion is associated with a broad suppression of Th cells and an increased IL-10 response.Conclusions Our results show that blood transfusion is associated with immunomodulation in obstetric haemorrhage patients, suggesting more stringent criteria for blood transfusion should be taken into account in the obstetric haemorrhage patients.

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

“…Nevertheless, transfusion in patients with low Hb concentration without clinical signs of anaemia has little effect on physical fatigue 800,801 . RBC transfusion seems to increase the risk of VTE 802 and cause immunomodulation in women with PPH 803 . Furthermore, RBC transfusion seems to be associated with reduced breastfeeding beyond the impact of anaemia, 804,805 and possibly a development of cardiovascular disease later in life 806 or cancer 807 .…”

“…800,801 RBC transfusion seems to increase the risk of VTE 802 and cause immunomodulation in women with PPH. 803 Furthermore, RBC transfusion seems to be associated with reduced breastfeeding beyond the impact of anaemia, 804,805 and possibly a development of cardiovascular disease later in life 806 or cancer. 807 In this context, a restrictive strategy (Hb threshold 7 g dl À1 ) seems equally safe and justified.…”

Can measuring blood loss at delivery reduce hemorrhage-related morbidity?

“…20,21 Finally, transfusion-related immunomodulation has been demonstrated after obstetric hemorrhage, and its implications are unknown. 22 Adopting a restrictive transfusion strategy once bleeding is under control is warranted in order to minimize these risks. 23 A systematic way to generate accurate, reliable QBL may help to prevent unnecessary transfusion and associated morbidity.…”

Storage Time of Filtered Red Blood Cells and Post-Transfusion Complications (Review)

“…One of the most needed blood components for transfusion are red blood cells (RBC), which deliver oxygen to the tissues. Transfusion of erythrocytes is necessary in massive blood loss, trauma, anemia, cancer therapy, sepsis [1][2][3][4][5]. However, transfusion medicine specialists commonly come up against the fact that red blood cell transfusion can have both beneficial and adverse effects.…”