Transfusion of buffy coat‐depleted blood components and risk of postoperative infection in orthopedic patients

Abstract

Buffy coat-depleted allogeneic blood transfusion increases the incidence of postoperative infection in patients undergoing uncontaminated orthopedic surgery.

An algorithm to reduce allogenic red blood cell transfusions for major orthopedic surgery

“…Apart from well-known risks, such as the transmission of infections or transfusion reactions, there is concern-especially in orthopedic surgery-about a causal relationship between allogenic red blood cell transfusions and immunomodulation. Transfusion-related immunosuppression is thought to increase the incidence of postoperative infections, delay healing of postoperative wounds and thereby prolong hospitalization (Murphy et al 1991, Blumberg 1997, Bierbaum et al 1999, Innerhofer et al 1999, Borghi and Casati 2000. In our prospective study-which included 975 major orthopedic surgical procedures, such as total hip arthroplasty and knee replacement surgery, fusion surgery of the lumbar, thoracic or cervical spine-we confirm this view (Table 1).…”

The effect of tranexamic acid in blood loss and transfusion volume in adolescent idiopathic scoliosis surgery: A single-surgeon experience

“…Triulzi et al [10] found a markedly higher rate of infection in postoperative spinal fusion patients who received allogenic transfusions (20.8 %) as opposed to those who did not (3.8 %). The mechanism behind transfusion immunomodulation remains unclear [10][11][12][13].…”

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

“…61 Until recently, observational studies reporting an association between allogeneic blood transfusion and postoperative infection did not adjust for the effects of severity of illness and/or risk factors for postoperative infection at specific sites. Some teams of investigators secured partial control for the effects of these variables by excluding UTIs from the definition of postoperative infection 69,71 ; by limiting the outcome variable to postoperative wound infection [72][73][74] ; or by adjusting for the effects of serum albumin, 75,76 insertion of a urinary catheter, 77,78 or presence of chronic systemic illness, 70 or diabetes mellitus. 79 However, adjustment for the effects of all these factors in combination has rarely been presented in the literature.…”

“…The summary OR across the 7 studies was 2.4 (95% confidence interval [CI], 1.6-3.6; P Ͻ .0001). Figure 2 updates the meta-analysis of Duffy and Neal 20 by including the study of Innerhofer et al 78 The 8 available studies were homogeneous (P ϭ .50 for the Q test statistic), and the summary OR of postoperative infection in the allogeneic (compared with the autologous) transfusion group was 2.1 (95% CI, 1.3-3.4; P Ͻ .001).…”