Immunologic changes after transfusion of autologous or allogeneic buffy coat-poor versus WBC-reduced blood transfusions in patients undergoing arthroplasty. II. Activation of T cells, macrophages, and cell-mediated lympholysis
P. Innerhofer et al., Immunologic changes after transfusion of autologous or allogeneic buffy coat-poor versus WBC-reduced blood transfusions in patients undergoing arthroplasty. II. Activation of T cells, macrophages, and cell-mediated lympholysis, TRANSFUSION, 40(7), 2000, pp. 821-827
BACKGROUND:To estimate the impact of RBC preparations on the status of post
operative immune activation, the soluble cytokine receptors of TNF alpha (s
TNF-R) and IL-2 (sIL-2R), as well as neopterin and cell-mediated lympholysi
s (CML), were measured.
STUDY DESIGN AND METHODS: Patients undergoing strictly standardized anesthe
siologic management for elective orthopedic surgery were enrolled in a pros
pective study. The perioperative course (Days 0, 3, 7, and 10) of sTNF-R, s
IL-2R, neopterin, and CML was compared after random assignment to allogenei
c buffy coat-reduced (Group 2, n = 8) or WBC-reduced (Group 3, n = 11) RBC
transfusion regimen. Recipients of autologous huffy coat-reduced RBC transf
usions (Group 1, n = 15) served as controls. Patients receiving intraoperat
ively and postoperatively salvaged blood only (n = 10) were separately anal
yzed as Group 4.
RESULTS: In Group 1, a short-lasting increase in soluble cytokine receptors
, a diminished cytolytic response (Day 0 vs. Day 7. sTNF-R, p = 0.0001; sIL
-2R, p = 0.0004; CML, p = 0.0238), and an elevation of neopterin (Day 0 vs.
Day 3. p = 0.0064) were observed. In contrast, in allogeneically transfuse
d patients, sTNF-R (Group 2, p = 0.0469: Group 3, p = 0.0039), sIL-2R (Grou
p 3, p = 0.002) and neopterin (Group 3, p = 0.0164) increased further from
baseline to Day 10 (Day 0 vs. Day 10), and this increase was accompanied by
a diminished cytolytic response (Day 0 vs. Day 10: Group 2, p = 0.05; Grou
p 3, p = 0.0076). Patients in Group 4 showed a short-lasting increase in sI
L-2R (Day 0 vs. Day 3. p = 0.0078), neopterin (Day 0 vs. Day 3. p = 0.0156)
and sTNF-R (Day 0 vs. Day 7. p = 0.0781).
CONCLUSION: Allogeneic transfusions seem to prolong the postoperative statu
s of immune activation, even when WBC-filtered RBCs are used for the transf
usion regimen.