Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery

Abstract

The frequency of infection in 197 patients undergoing elective colorectal surgery and having either no blood transfusion, transfusion with whole blood, or filtered blood free from leucocytes and platelets was investigated in a prospective randomized trial. Natural killer cell function was measured before operation and 3, 7 and 30 days after surgery in 60 consecutive patients. Of the patients 104 required blood transfusion; 48 received filtered blood and 56 underwent whole blood transfusion. Postoperative infections developed in 13 patients transfused with whole blood (23 per cent, 95 per cent confidence interval 13-32 per cent), in one patient transfused with blood free from leucocytes and platelets (2 per cent, 95 per cent confidence interval 0.05-11 per cent) and in two non-transfused patients (2 per cent, 95 per cent confidence interval 0.3-8 per cent) (P less than 0.01). Natural killer cell function was significantly (P less than 0.001) impaired up to 30 days after surgery in patients transfused with whole blood. These data provide a strong case against the use of whole blood transfusion in patients undergoing elective colorectal surgery.

Perioperative blood transfusion is associated with a gene transcription profile characteristic of immunosuppression: a prospective cohort study

“…The association between blood transfusion and infectious complications in the perioperative period has been well described previously [2,3,27]. This association appears to be consistent amongst cohorts that received either whole blood or leukodepleted blood.…”

“…The unintended clinical consequences of immune modulation by allogenic blood in the perioperative period include an increased susceptibility to infectious complications and cancer recurrence [2,3]. As inpatient non-cardiac surgery has recently been associated with much higher than anticipated mortality rates, it is now imperative that all potentially avoidable causes of excess morbidity in this population are investigated and addressed [4].…”

“…Although numerous small studies have suggested that perioperative allogenic blood transfusion may induce immune modulations that create an environment that promotes both microbial growth and tumorigenesis their conclusions are limited by small cohort size, in vitro and ex vivo assays and insensitive protein assays [3,[21][22][23][24][25][26]. In addition, these studies largely predate the routine leukodepletion of transfused blood and suggest a causal relationship between immune modulation and the infusion of allogeneic leukocytes; a biological effect that could be ameliorated by pre-storage leukodepletion [22].…”

Will we ever know if leukoreduction of red blood cells should be performed?

“…In two of the three studies that showed differences, the observed effects were much larger than seems biologically plausible. 12,13 One trial found a reduction in mortality associated with leukoreduction, although infection rate was not significantly improved. 14 Thus, a meta-analysis is needed.…”

The effect of potato starch derived and corn starch derived hydroxyethyl starch on in vitro blood coagulation

“…We conclude that potato starch derived hydroxyethyl starch compromises in vitro blood coagulation more than corn starch derived hydroxyethyl starch. Avoiding allogeneic blood transfusion has become an important issue in surgery and intensive care medicine with increasing awareness of the potential side-effects [1,2]. Besides transmission of infectious diseases, the increased incidence of postoperative infections with prolonged hospitalisation and increased costs [3] has recently created much interest.…”