Transfusion of red cells is associated with increased incidence of bacterial infection after colorectal surgery: a prospective study

Houbiers, J. G. A.; Veld, C.J.H. van de; Watering, Leo M.G. van de; Hermans, J.; Schreuder, Sanne M.; Bijnen, A. B.; Pahlplatz, Paul V. M.; Schattenkerk, M. Eeftinck; Wobbes, Th.; Vries, J.E. de; Klementschitsch, P; Maas, Annelies; Brand, A.

doi:10.1046/j.1537-2995.1997.37297203513.x

Cited by 213 publications

(121 citation statements)

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“…2,5 In particular, various studies in both clean orthopedic and potentially contaminated abdominal surgery have all suggested significantly fewer infections in transfusion patients. 6,[10][11][12]14 Although posttransfusion lymphopenia is likely to contribute to the impaired host defense against infections, the inhibitory effect, shown here, of TGF-␤1 on neutrophil chemotactic responsiveness appears to depict a new scenario. TGF-␤1 is a 25-kDa homodimer that has been shown to be a natural and potent inhibitor of various immunologic responses, 35 and it may contribute substantially to the reported immunosuppressive effects in recipients of RBC transfusions.…”

Section: Discussionmentioning

confidence: 82%

“…[1][2][3][4][5][6][7][8][9] Moreover, 4 out of 5 randomized controlled trials investigating the relationship between white blood cellcontaining versus white blood cell-depleted allogeneic blood transfusions and the development of postoperative infections, show at least a trend toward an increased incidence of infections in association with white blood cell-containing transfusions. [10][11][12][13][14] Consistent with the possible increased risk of postoperative infections in transfusion patients, various studies suggest that transfusions can induce immunomodulatory effects, including transient reduction in the CD4/CD8 T-cell ratio, reduced natural killer function, impaired lymphocyte mitogenic responses, and inhibition of delayed hypersensitivity.…”

Section: Introductionmentioning

confidence: 99%

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Transforming growth factor–β1 in supernatants from stored red blood cells inhibits neutrophil locomotion

Ghio

Ottonello

Contini

et al. 2003

Blood

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Studies comparing transfusion and nontransfusion patients suggest an increased risk of postoperative infections in transfusion groups. Supernatants of blood components have been shown to affect the function of T lymphocytes and natural killer cells. Here, we found that supernatants from stored red blood cells (RBCs) inhibit human neutrophil migration in response to formyl peptides and stimulate neutrophil locomotion. These effects can be observed with high dilutions of RBC supernatants, such as 1:5 ؋ 10 6 (vol/vol), able to trigger locomotion as well as desensitization of the cells to alternative chemoattractants. The phenomenon might be mediated by chemoattractants present in the supernatants. As RBC supernatants failed to mobilize intracellular free calcium, the chemoattractants should belong to the group of pure chemoattractants, that is, soluble Fas ligand (sFasL) and transforming growth factor-␤1 (TGF-␤1), known to act without increasing calcium levels. Recombinant TGF-␤1, but not sFasL, was found to reproduce the ability of RBC supernatants to both inhibit neutrophil response to formyl peptides and stimulate neutrophil locomotion. Moreover, TGF-␤1-immunodepleted supernatants did not display neutrophildirected activities. Finally, RBC supernatants from RBCs stored after depletion of leukocytes were incapable of affecting neutrophil function. With neutrophils acting as a first-line antimicrobial defense, the ability, shown here, of high dilutions of RBC supernatants to inhibit neutrophil chemotaxis through TGF-␤1 may be a relevant determinant of infections in the postoperative period for transfusion patients. Consistently, the neutrophil chemotactic response to formyl peptide was inhibited by the plasma obtained from 5 transfusion patients.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Transforming growth factor–β1 in supernatants from stored red blood cells inhibits neutrophil locomotion

Ghio

Ottonello

Contini

et al. 2003

Blood

View full text Add to dashboard Cite

show abstract

“…The observation that iron administration in this not-iron-deficient population has no effect on Hb increase confirms previous observations by Olijhoek et al 9 Many studies have been performed to evaluate the impact of blood transfusions on hospitalization time, recovery, and infection rate. [10][11][12][13][14][15][16] These studies all confirm a relation between allogeneic blood transfusions and increased risk of infections and/or length of hospital stay. But the absolute numbers differ significantly between studies.…”

Section: Discussionmentioning

confidence: 67%

Blood Transfusions and Postoperative Recovery in Orthopedic Surgery. The European Eprex Surgery Trial

Slappendel

Weber

2004

Transfus Alt Transfus Med

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“…41 Although these studies imply that the transfusion of blood products increases the risk of infection, some studies have not noted an increased risk, 42 and others have argued that the effect of transfusion is minor. 37 Nevertheless, the risk of infection with transfusion can be decreased using autologous blood donation 37 versus allogenic blood.…”

Section: Blood Transfusion and The Risk Of Infectionmentioning

confidence: 99%

The Anesthesiologist's Role in the Prevention of Surgical Site Infections

Mauermann

Nemergut²

2006

Anesthesiology

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This article has been selected for the Anesthesiology CME Program. After reading the article, go to http:// www.asahq.org/journal-cme to take the test and apply for Category 1 credit. Complete instructions may be found in the CME section at the back of this issue.SURGICAL site infections (SSIs) continue to be a substantial source of morbidity and mortality in the surgical patient population. They are the second most common cause of nosocomial infection after urinary tract infections and account for approximately 17% of all hospital-acquired infections. 1 These infections lead to longer hospital and intensive care unit stays, lead to substantially increased mortality, and contribute significantly to healthcare costs. 2 In a 1999 series of cardiac surgery patients, each deep sternal wound infection added an average of $26,400 in hospital charges and increased the average duration of stay by 16 days. 3 The incidence of SSI varies for each operative procedure, each surgeon, and each hospital. In addition, each patient presents with his or her own unique risk profile for the development of a SSI. Although sterile surgical technique is extremely important to the prevention of SSIs, there is increasing evidence that anesthesiologists play a prominent yet under appreciated role in the prevention of SSIs. While infections typically present several days postoperatively, the first few hours after bacterial contamination are the critical window for the establishment of infection. 4,5 Therefore, decreasing SSIs hinges on the optimization of perioperative conditions, many of which are controlled by anesthesiologists.In this review, we will discuss the literature surrounding six perioperative factors over which anesthesiologists have at least partial control and how these factors may influence the risk of postoperative surgical site infection. Although we acknowledge that many anesthesiologists care for patients in the intensive care unit, we limit our discussion here to the immediate perioperative period. HypothermiaMild perioperative hypothermia (core body temperature 34°-36°C) is commonly observed in surgical patients. The complications of mild perioperative hypothermia have been studied extensively and include increased duration of hospitalization, 5 increased intraoperative blood loss and transfusion requirements, increased adverse cardiac events, and an increase in patient thermal discomfort in the recovery room. 6 The effects of mild hypothermia on SSI have also been studied.A series of 200 patients undergoing colorectal surgery were randomized to a hypothermic group (34.4°Ϯ 0.4°C) or a normothermic group (37°Ϯ 0.3°C) and followed for 2 weeks postoperatively. 5 The authors had planned to enroll 400 patients; however, the trial was stopped early because of a statistically significant difference in infection between the two groups. The incidence of SSI was 5.8% in the normothermic group and 18.8% in the hypothermic group. The patients who developed SSIs required hospital stays nearly 1 week longer than those who did not d...

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Transfusion of red cells is associated with increased incidence of bacterial infection after colorectal surgery: a prospective study

Cited by 213 publications

References 43 publications

Transforming growth factor–β1 in supernatants from stored red blood cells inhibits neutrophil locomotion

Transforming growth factor–β1 in supernatants from stored red blood cells inhibits neutrophil locomotion

Blood Transfusions and Postoperative Recovery in Orthopedic Surgery. The European Eprex Surgery Trial

The Anesthesiologist's Role in the Prevention of Surgical Site Infections

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