Transfusion-related immunomodulation (TRIM): An update

Impact of Allogenic and Autologous Transfusion on Immune Function in Patients with Tumors

“…On postoperative day 3 to 7, there was no significant difference between any groups at any time point, indicating either autotransfusion or allogeneic blood transfusion has comparatively small effect on the plasma concentrations of TNF-α. A study, which researches impact of blood transfusion on tumor necrosis factor in patients with lung cancer, has also found that after allogeneic blood transfusion there is no significant change of patients' plasma TNF-α (Vamvakas et al, 2007). The finding is consistent with the result of this study.…”

Transfusion-transmissible infections and transfusion-related immunomodulation

“…Particular to transfusion medicine is that results from clinical studies are quite difficult to analyse and interpret according to the mostly heterogeneous study populations, the lack of a universally applied transfusion trigger and blood product manufacturing that differs from one Vamvakas et al [68] categorize in their review the twenty-two available randomized controlled trials based on the inference that they permit about possible mediators of TRIM, and examine the strength of evidence available for relying on WBC reduction or autologous transfusion to prevent TRIM effects (i.e. higher overall mortality risk, higher rate of infectious complications, higher cancer recurrence rate).…”

Should intraoperative cell-salvaged blood be used in patients with suspected or known malignancy?

“…9 The morbidity and mortality associated with transfusion of allogeneic blood is attributed to a complex, poorly understood interaction between host tissue and transfused allogeneic blood components termed transfusion-related immunomodulation (TRIM). 15,16 The immunomodulatory properties of allogeneic blood were first recognized following observations of improved renal allograft survival in patients who had received perioperative blood transfusion. 17,18 Leukocytes and their soluble and cellular breakdown products are thought to contribute significantly to TRIM.…”

“…17,18 Leukocytes and their soluble and cellular breakdown products are thought to contribute significantly to TRIM. 15 Subsequent leukoreduction (LR) of select blood components was initially undertaken to decrease the incidence of adverse events that were known to be related to the leukocyte component of donor products (febrile nonhemolytic transfusion reaction, transmission of cytomegalovirus, and human leukocyte antigen alloimmunization). Universal prestorage LR was implemented to minimize these complications.…”

“…The effectiveness of universal prestorage LR programs is controversial and continues to be debated. 15,19,25 An additional consideration affecting the patient undergoing malignancy resection is whether allogeneic blood transfusion causes immunosuppression that contributes to an increased risk of subsequent cancer recurrence, an observation first described in 1982. 26 Impaired function of natural killer cells, decreased T cell production, alteration of T cell ratios, and defective antigen-presenting cell number and function have all been associated with transfusion of allogeneic blood and are thought to be an important contributor to TRIM.…”