Abstract:Context Leukocytes present in stored blood products can have a variety of biological effects, including depression of immune function, thereby increasing nosocomial infections and possibly resulting in organ failure and death. Premature infants, given their immature immune state, may be uniquely predisposed to the effects of transfused leukocytes. Objective To evaluate the clinical outcomes following implementation of a universal prestorage red blood cell (RBC) leukoreduction program in premature infants admit… Show more
“…This retrospective study compared the time period before and after introduction of universal prestorage leukoreduction in three different sites in Canada. 16 In this study, there was a bias towards the null effect because a large portion of the patients in the nonleukoreduction group received post-storage washed cells. Although there was no reduction of mortality, there was significant reduction in morbidities, including retinopathy of prematurity, bronchopulmonary dysplasia, severe intraventricular hemorrhage and necrotizing enterocolitis following prestorage leukoreduction.…”
“…This retrospective study compared the time period before and after introduction of universal prestorage leukoreduction in three different sites in Canada. 16 In this study, there was a bias towards the null effect because a large portion of the patients in the nonleukoreduction group received post-storage washed cells. Although there was no reduction of mortality, there was significant reduction in morbidities, including retinopathy of prematurity, bronchopulmonary dysplasia, severe intraventricular hemorrhage and necrotizing enterocolitis following prestorage leukoreduction.…”
“…No clear statement can be made whether universal leukoreduction was indeed associated with any clinical advantage with regard of overall mortality rate, infection rate, or cancer recurrence [74], [75], [76], [77], [78].…”
Section: Clinical Studies On Transfusion-related Immunomodulationmentioning
Transfusion-transmissible infections and transfusion-related immunomodulation AbstractThe risk of acquiring a transfusion-transmitted infection has declined in recent years. However, after human immunodeficiency virus and hepatitis B and C virus transmission were successfully reduced, new pathogens are threatening the safety of the blood supply, especially in the face of rising numbers of immunocompromised transfusion recipients. Despite new standards in the manufacture and storage of blood products, bacterial contamination still remains a considerable cause of transfusion-related morbidity and mortality. Better allograft survival in kidney transplant patients and higher cancer recurrence rate in surgical oncology patients after allogeneic blood transfusions highlighted a previously underestimated side-effect: transfusion-related immunomodulation (TRIM). The precise pathomechanism still remains uncertain; however, its mostly deleterious effects--such as a higher incidence of postoperative or nosocomial infections--is increasingly accepted. Although transfusion-related immunomodulation is thought to be mediated mainly by donor white blood cells, the benefit of leukoreduction on overall mortality and on infectious complications is highly debatable.
Transfusion-transmissible infections and
Transfusion-related immunomodulation
Transfusion-transmissible infections and
Transfusion-related immunomodulation AbstractThe risk of acquiring a transfusion-transmitted infection has declined in recent years.
“…Some evidence suggests a decrease in the risk of TRALI and transfusion-related acute circulatory overload [95]. It may also reduce TRIM, although the association with postoperative infections, multi-organ dysfunction and death is less clear [120,121]. Whilst prestorage leukoreduction is mandatory in Canada and most of Europe, it is only recommended by the FDA in the USA, reflecting the lack of definitive risk-cost benefit evidence [122].…”
SummaryUnderstanding the complex immunological consequences of red cell transfusion is essential if we are to use this valuable resource wisely and safely. The decision to transfuse red cells should be made after serious considerations of the associated risks and benefits. Immunological risks of transfusion include major incompatibility reactions and transfusion-related acute lung injury, while other immunological insults such as transfusion-related immunomodulation are relatively underappreciated. Red cell transfusions should be acknowledged as immunological exposures, with consequences weighed against expected benefits. This article reviews immunological consequences and the emerging evidence that may inform risk-benefit considerations in clinical practice.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.