Intraoperative Cell Salvage as an Alternative to Allogeneic (Donated) Blood Transfusion: A Prospective Observational Evaluation of the Immune Response Profile

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.

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

“…Salvaged blood can be passed through individual or double filters or with leukoreduction capacity. The immunological benefit of salvaged blood is not well defined; however, preliminary experimental studies suggest that the procedure may be advantageous [ 186 ].…”

Safety of intra‐operative blood salvage during liver transplantation in patients with hepatocellular carcinoma, a propensity score‐matched survival analysis

“…Intra-operative blood salvage (IBS) is a technique that uses autologous blood transfusion and is a widely used strategy during surgery with potential massive blood loss in order to decrease use of allogenic blood transfusion. The mechanism relies on retrieving autologous blood through suction in the operating field, followed by a process of filtration and finally reinfusion [1,2]. Despite extensive use of the IBS during major abdominal surgery and liver transplantation for non-malignant disease, use of IBS remains controversial during liver transplantation in hepatocellular carcinoma (HCC) patients [3].…”

Risk factors of nosocomial infection in patients underwent artificial liver support system: a retrospective case–control study

“…Although in many cases, allogeneic blood transfusion can save patients' lives, it also may bring risks of infections [30], which was confirmed by the results of this study where allogeneic blood transfusion was an independent risk factor for nosocomial infection. In addition to the direct invasion of pathogenic microorganisms, the initiation of transfusion-related immune regulation that inhibits the immune system is also an important factor leading to the increased risk of infection in patients with allogeneic blood transfusions [31]. Allogeneic blood transfusion is equivalent to allogeneic tissue transplantation.…”