Transfusion immunomodulation from a clinical perspective: an update

Abstract

Accumulated evidence demonstrates that allogeneic blood transfusions have clinically significant effects on the recipient's immune system. This transfusion immunomodulation effect is associated with an increased rate of cancer recurrence (uncertain causality) and post-operative infection (established causality). The exact mechanisms of transfusion immunomodulation are still unknown. Data suggests that transfusion immunomodulation is a biologic effect strongly associated with the infusion of allogeneic leukocytes. Soluble mediators that accumulate in transfused red cells and platelets during storage are also possible causes of post-transfusion complications. Some approaches can mitigate these effects. Most important is adopting more conservative transfusion practices. Leukoreduction (proven) and plasma depletion (proposed) are other methods to significantly reduce transfusion immunomodulation and its clinical sequela.

Blood transfusion is associated with increased risk of perioperative complications and prolonged hospital duration of stay among patients undergoing amputation

“…41 The most likely reason is the well-described, transfusionassociated immunomodulation effect associated with increased rate of postoperative infection. 42,43 In this study, after adjusting for all the confounding variables, we observed similarly that the risk of major infectious complication, including pneumonia and SSI, was greater with transfusion after a major amputation.…”

Characteristics of Extracellular Vesicles in Red Blood Concentrates Change with Storage Time and Blood Manufacturing Method

“…The quality assurance of the blood components is vital during processing and storage for the patient safety [3]. Although several accomplishments have been made to maintain the integrity and function of blood cells and to improve the quality of stored blood components for better transfusion outcomes [4,5,6,7,8], a number of studies have revealed that transfusion of red blood cell (RBC) products is still associated with increased risk of adverse clinical events [9,10,11,12,13,14,15]. Many recent studies have focused on effects of storage duration on the quality of blood products and their clinical consequences [10,11,13,16,17].…”

Transfusion et inflammation : hier – aujourd’hui – demain

“…Le bénéfice général de la leucoréduction est ainsi largement supérieur à l'effet Transfusion Related Immuno Modulation (TRIM) que peut apporter un PSL non leucoréduit. Plusieurs revues proposent une bonne analyse de la situation [26][27][28].…”