Cellular immune response to autologous blood transfusion in hip arthroplasty: whole blood versus buffy coat‐poor packed red cells and fresh‐frozen plasma

In five studies comparing different forms of storage of autologous blood the allogenic transfusion rate, humoral and cellular immune parameters and the postoperative infection rate were investigated. In a prospective, randomized study 21 volunteers donated one unit of blood. Retransfusion of stored autologous whole blood, but not of autologous packed red cells and fresh frozen plasma, induced a limited response of the immune system. Four prospective, randomized, partially or totally blinded studies investigating autologous donation in primary hip arthroplasty were carried out: In the first study including 94 patients, in which autologous blood was stored as whole blood, leukocyte-depleted whole blood or as blood components, the allogenic transfusion rates were compared. The type of storage of autologous blood did not influence homologous transfusion requirements. In a second study dealing with humoral immune factors, 97 patients were allocated at random to two groups. In one group, the autologous donation was stored as whole blood, in the other group the donation was separated into blood components before storage. With respect to the parameters studied, there were no significant differences between patients transfused with whole blood and those transfused with blood components. Moreover, these values also did not differ from those of patients not transfused. In a third study, the phagocytosis and respiratory burst activity of neutrophil granulocytes and of monocytes was measured in 58 patients who were randomly allocated to two groups as in the previous study. Neither the time course of phagocytosis nor that of respiratory burst activity showed a significant difference between both groups. In a fourth multicenter study, 953 patients were allocated to either of two groups. The first group of patients received autologous blood stored as whole blood, in the second group leukocyte depletion was done before storage. When comparing the outcomes of both groups, it could be shown that leukocyte depletion of autologous whole blood did not reduce the number of postoperative infections in primary hip surgery. It is therefore concluded that neither leukocyte depletion nor blood component separation is mandatory when using autologous predeposit in primary hip arthroplasty.

Section: Discussionmentioning

confidence: 99%

Section: Hip Arthroplasty: Cellular Immune Systemmentioning

confidence: 99%

Autologous Predeposit: To Leukocyte Deplete Or Not to Leukocyte Deplete?

Weiler-Lorentz¹,

Frietsch²

2006

“…It has been claimed -though not demonstrated -that a longer permissible storage time reduces the homologous transfusion rate in patients participating in a predeposit program [25,26]. Previous investigation to clarify this issue had been criticized because SAG-Mannitol had been used as additive solution allowing only 6 weeks of storage [27] or cell salvage had been used in addition to predeposit and the permissible storage time had not been fully utilized [28,29]. The present study is not prone to this kind of criticism.…”

Section: Discussionmentioning

confidence: 99%

The Type of Storage of Autologous Blood Does Not Influence Homologous Transfusion Requirements in Hip Arthroplasty

Lorentz¹,

Klever²,

Dempfle³

et al. 2001

Self Cite

Background: The new German regulations for hemotherapy require the use of autologous blood as buffy coat-poor packed red cells (PRC) and fresh frozen plasma (FFP) or as leukocytedepleted whole blood (ldWB). There are no data, however, documenting reduced allogeneic transfusion rates and/or a better outcome with PRC/FFP or ldWB. We investigated whether storage as processed blood results in a different rate of homologous transfusion in patients undergoing surgery for hip arthroplasty. Patients and Methods: After informed consent 94 patients (48 men, 46 women, age 36–78 years) scheduled for hip arthroplasty and predepositing autologous blood were allocated at random to either of three groups: group WB (predeposit stored as unprocessed whole blood, surgery in the 5th week after the first donation), group ldWB (leukocyte-depleted whole blood, surgery in week 6) and group PRC/FFP (packed red cells and fresh frozen plasma, surgery in week 7). Three units were requested, deferral hemoglobin concentration was 11 g/dl. Results: Hemoglobin concentration prior to donation was measured as 13.8 ± 1.0, 14.2 plusmn; 1.1, 14.0 plusmn; 1.1 g/dl in groups WB, ldWB and PRC/FFP, respectively (mean plusmn; standard deviation); hemoglobin concentration prior to surgery as 13.0 plusmn; 1.3*, 13.5 plusmn; 1.4, 13.8 plusmn; 1.1* g/dl (*p < 0,05). Blood loss amounted to 2,270 (970–3,760), 1,850 (930–3,680) and 1,680 (480–3,390) ml (median, range) (n.s.). Two patients in group WB, 2 in group ldWB, and 1 in group PRC/FFP required allogeneic transfusion (n.s.). Conclusions: The type of storage of autologous predeposit does not seem to influence the allogeneic transfusion rate in hip arthroplasty. The patients in groups ldWB and PRC/FFP were allowed more time for erythropoiesis, but red cells were lost due to processing of the blood. The data do not support the concept to leukocyte-deplete autologous blood or to produce components.

“…In another clinical trial with a similar design and studying changes of immunological parameters, i.e. surrogate endpoints, Frietsch et al [8] randomized total hip arthroplasty patients to receive either (non-LD) AWB or autologous buffy coat-depleted RCC if transfusion was indicated. They measured the phagocytic activity of granulocytes and monocytes and did not find any differences among the groups.…”

Section: Introductionmentioning

confidence: 99%

“…The results of these studies are summarized in table 1. The studies were either to small to detect any significant differences between groups receiving autologous blood products with different leukocyte content [8,9] or had employed an inferior study design where causal inferences with respect to immunomodulatory effects of autologous leukocytes need to be made with caution [10]. Thus, a randomized controlled trial with sufficient patient numbers to detect meaningful differences in clinically relevant endpoints was initiated [11].…”

Section: Introductionmentioning

confidence: 99%

Immunomodulatory Effects of Non-Leukocyte-Depleted and Leukocyte-Depleted Autologous Blood

Karger

Weber²,

Schmidt³

et al. 2006

Based on several in vitro experiments, it has been suggested that autologous blood transfusion might lead to immunomodulation and that this effect might be prevented by leukocyte depletion. Clinical studies with surrogate endpoints showed conflicting results, whereas studies documenting clinically relevant outcomes were either too small or methodologically suboptimal to answer this question. Patients and Methods: Participants of a randomized multicenter trial were studied. Patients were scheduled for total hip arthroplasty and preoperative autologous blood donation (PABD) of 2 or more autologous whole blood units. Immunological parameters were investigated prior to first donation, prior to surgery and on days 1, 5, and 10 after surgery. Results: Leukocyte and lymphocyte subsets changed slightly after donation and considerably after surgery. Monocyte function was slightly suppressed following donation and substantially impaired after surgery. Transfusion slightly counteracted this effect. Leukocyte depletion did not result in any significant changes of the investigated immunological parameters. Conclusion: Following PABD immunological changes in patients occur that can be attributed mainly to the donation process and surgery. Transfusion has a minor effect. Leukocyte depletion does not appear to contribute substantially to these changes.