Transfusion associated microchimerism: a heretofore little recognized complication following transfusion

Abstract

Potent antiplatelet and antithrombotic agents have significantly reduced mortality in the setting of acute coronary syndromes and percutaneous coronary intervention. However these agents are associated with increased bleeding which is in turn associated with adverse clinical outcomes. In many centers, transfusion is often used to correct for blood loss. Blood transfusion in the setting of acute coronary syndrome has been associated with adverse clinical outcomes including increased mortality. Transfusion associated microchimerism (TA-MC) is a newly recognized complication of blood transfusion. There is engraftment of the donor's hematopoietic stem cells in patients who then develop microchimerism. This article discusses the association of bleeding/blood transfusion with adverse outcomes and the potential role of TA-MC in clinical outcomes.

Lack of effect of unrefrigerated young whole blood transfusion on patient outcomes after massive transfusion in a civilian setting

“…Finally, leukoreduction without filtering PLTs for unrefrigerated young whole blood is technically difficult 14,15 . Without leukoreduction microchimerism may occur which may have potential adverse long‐term consequences 20,21 . Therefore, the short‐ and long‐term risks and benefits of unrefrigerated young whole blood in patients requiring massive transfusion in a civilian setting remain uncertain; an adequately powered randomized controlled trial is needed before unrefrigerated young whole blood can be recommended for massive transfusion in a civilian setting 4,22,23 .…”

“…14,15 Without leukoreduction microchimerism may occur which may have potential adverse long-term consequences. 20,21 Therefore, the shortand long-term risks and benefits of unrefrigerated young whole blood in patients requiring massive transfusion in a civilian setting remain uncertain; an adequately powered randomized controlled trial is needed before unrefrigerated young whole blood can be recommended for massive transfusion in a civilian setting. 4,22,23 Three ongoing randomized controlled trials on effects of fresh or young blood versus aged blood (>2-3 weeks) may also inform us about the advantages of fresh or young whole blood transfusion for patients requiring transfusion in nonemergent situations in a civilian setting (ClinicalTrials.gov identifiers: NCT00838331, NCT01038557, and NCT00141674).…”

Extracellular DNA in blood products and its potential effects on transfusion

“…Regarding blood transfusion, microchimerism from non-leukoreduced cellular blood products has been found to persist from months to years after transfusion in traumatically injured patients [122]. Transfusion-associated microchimerism appears to be an identified complication of blood transfusion [123,124]. Whether patients with transfusion-associated microchimerism have consequent adverse health effects, such as transfusion associated graft-versus-host disease, is still under investigation.…”

Verification of the genomic identity of candidate microchimeric cells

“…This is important not only if we want to safely identify microchimeric cells in tissues in the context of research in autoimmune diseases, 1 in tissue repair and regeneration, 2 in cancer, 3 transplantation and transfusion 4,5 and pregnancy complications, 6 but also of very practical relevance for the quest of cell-based non-invasive prenatal diagnosis, which relies decisively on safe identification of single cells which are part of the very small population of fetal cells present in the peripheral blood of pregnant women. In general, due to the problem of population overlap detection on the basis of biochemical parameters, even highly specific markers such as embryonic hemoglobin (Hbε) expressed by embryonic nucleated red blood cells cannot lead to perfectly safe identification of rare single cells.…”