The Impact of Two Different Transfusion Strategies on Patient Immune Response during Major Abdominal Surgery: A Preliminary Report

Abstract

Blood transfusion is associated with well-known risks. We investigated the difference between a restrictive versus a liberal transfusion strategy on the immune response, as expressed by the production of inflammatory mediators, in patients subjected to major abdominal surgery procedures. Fifty-eight patients undergoing major abdominal surgery were randomized preoperatively to either a restrictive transfusion protocol or a liberal transfusion protocol (with transfusion if hemoglobin dropped below 7.7 g dL−1 or 9.9 g dL−1, respectively). In a subgroup of 20 patients randomly selected from the original allocation groups, blood was sampled for measurement of IL-6, IL-10, and TNFα. Postoperative levels of IL-10 were higher in the liberal transfusion group on the first postoperative day (49.82 ± 29.07 vs. 15.83 ± 13.22 pg mL−1, P < 0.05). Peak postoperative IL-10 levels correlated with the units of blood transfused as well as the mean duration of storage and the storage time of the oldest unit transfused (r 2 = 0.38, P = 0.032, r 2 = 0.52, P = 0.007, and r 2 = 0.68, P<0.001, respectively). IL-10 levels were elevated in patients with a more liberal red blood cell transfusion strategy. The strength of the association between anti-inflammatory IL-10 and transfusion variables indicates that IL-10 may be an important factor in transfusion-associated immunomodulation. This trial is registered under ClinicalTrials.gov Identifier: NCT02020525.

Perioperative blood transfusion is not associated with overall survival or time to recurrence after resection of perihilar cholangiocarcinoma

“…Transfusions can still cause alloimmunization, transmission of viral diseases, graft-versushost disease, and an increased post-operative infection rate. 4,6,7,55 It is important to make an individualized decision on the use of blood transfusion in every patient undergoing cancer surgery, in conjunction with other precautionary measures. 5 This retrospective study has several limitations.…”

“…Perioperative blood transfusions with packed red blood cells (pRBC) are used to compensate for critical blood loss, but have been associated with increased risk of tumor recurrence and decreased long-term outcome in several tumor types, including colorectal, prostate, lung, and head and neck cancer. [4][5][6][7][8][9][10][11] The effect of blood transfusions on prognosis is attributed to a distinct pathology of immunosuppression, known as transfusion-related immune modulation (TRIM). Blood transfusion seems to provoke an immune deviation 12 and changes in the anti-inflammatory/proinflammatory environment.…”

Biomarkers for Evaluating the Inflammation Status in Patients with Cancer

“…We grouped the published studies into three groups (Table 1) [34567891011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859606263646566676869707172737475767778798081]. The first group included studies that identified the characteristics of hosts exhibiting inflammation, the second group included studies that measured the effect of treatment interventions, and the third group included studies that predicted the outcomes of interventions.…”

Transfusion‐related immunomodulation: review of the literature and implications for pediatric critical illness

“…By contrast, the studies that found no effect, mixed effects, or immune‐suppressive effects associated with RBC transfusion largely employed leukoreduced RBC products . Immunosuppressive effects of transfusion have been studied most often in surgical patients . Whether these patients are more prone to immunosuppressive effects of RBC transfusion, or that other patient populations are understudied, is not clear.…”

“…Whether these patients are more prone to immunosuppressive effects of RBC transfusion, or that other patient populations are understudied, is not clear. Different immunosuppressive effects of transfusion have been observed, including decreased ability of immune cells to produce proinflammatory cytokines, increased production of anti‐inflammatory cytokines, and decreased function of T lymphocytes and NK cells . ‐ Effects of storage duration in the context of RBC TRIM are unclear, with some studies indicating a storage effect, while others do not.…”