Transfusion‐associated immunomodulation and universal white cell reduction: are we putting the cart before the horse?

Deleterious clinical effects of transfusion-associated immunomodulation: fact or fiction?

“…Table 5 looks at this question from a public policy (as opposed to an evidence-based medicine 109 ) perspective and summarizes the arguments for and against a policy to implement universal WBC reduction for the prevention of the adverse TRIM effects, based on the current state of knowledge. 26,27 All "pro" arguments are logical, and they are countered by equally reasonable "con" arguments. Therefore, any decision at this time to implement (or not to implement) universal WBC reduction in the United States for the purpose of preventing the purported deleterious TRIM effects will have to be arbitrary.…”

“…One can argue that a policy decision should be made on the basis of the existing evidence because better evidence is unlikely to be forthcoming. 26 Alternatively, one can argue that no policy decision should be made until it is possible to make such a decision based on sound scientific evidence. 27 Regardless of the content of the public policy debate, should universal WBC reduction be implemented, the question as to whether WBC-containing allogeneic blood transfusion causes deleterious TRIM effects will remain.…”

“…Both the earlier observational cohort studies and the recent RCTs have produced contradictory findings, and-because of the discrepancies among the published studies-the long-standing hypothesis of the potentially deleterious immunomodulatory effect of perioperative allogeneic blood transfusion remains unresolved. 11,26,27 The mechanism(s) of the TRIM effect(s) also remains elusive, and it is possible that a large number of biologic mechanisms may underlie the effect(s). [28][29][30][31] The infusion of foreign antigen in either a soluble [31][32][33][34][35][36] or cell-associated [37][38][39][40][41][42][43] form has been shown to induce immune suppression, anergy, and clonal deletion in studies in experimental animals.…”

“…These studies produced contradictory findings, and the issue as to whether any deleterious TRIM effects are lessened or abrogated by WBC reduction of the transfused allogeneic cellular blood components remains unresolved. 11,26,27,48 Jensen et al attributed an 86% 3 and a 71% 5 reduction in the incidence of postoperative infection to the use of WBC-reduced allogeneic whole blood 3 or RBCs, 5 with the use of poststorage WBC reduction by filtration. In contrast, Houbiers et al 22 found no difference in the incidence of postoperative infection between the recipients of WBC-reduced and buffy-coat-reduced RBCs with the use of prestorage WBC reduction by filtration.…”

Anesthetic Considerations for Management of Cancer Patients to Decrease Cancer Recurrence

“…IFNγ, Thelper cell, and T-helper/cytotoxic T-cell ratio were reduced in both groups after operation but the suppression was most profound in the allogeneic transfusion group. Five days after the operation, levels had returned to baseline for patients receiving autologous transfusions but remained suppressed in the allogeneic group [34]. Studies on this effect are controversial and remain inconclusive, as current literature does not clearly correlate TRIM with cancer recurrence [33,34].…”