Distinct roles of trauma and transfusion in induction of immune modulation after injury

Abstract

BACKGROUND Trauma and transfusion can both alter immunity, and while transfusions are common among traumatically injured patients, few studies have examined their combined effects on immunity. STUDY DESIGN AND METHODS We tracked the plasma levels of 41 immunomodulatory proteins in 56 trauma patients from time of injury up to 1 year later. In addition, a murine model was developed to distinguish between the effects of transfusion and underlying injury and blood loss. RESULTS Thirty-one of the proteins had a statistically significant change over time after traumatic injury, with a mixed early response that was predominantly anti-inflammatory followed by a later increase in proteins involved in wound healing and homeostasis. Results from the murine model revealed similar cytokine responses to humans. In mice, trauma/hemorrhage caused early perturbations in a number of the pro- and anti-inflammatory mediators measured, and transfusion blunted early elevations in IL-6, IL-10, MMP-9, and IFN-γ. Transfusion caused or exacerbated changes in MCP-1, IL-1α, IL-5, IL-15, and soluble E-selectin. Finally, trauma/hemorrhage alone increased KC and IL-13. CONCLUSIONS This work provides a detailed characterization of the major shift in the immunological environment in response to trauma and transfusion and clarifies which immune mediators are affected by trauma/hemorrhage and which by transfusion.

Decreased levels of perforin-positive lymphocytes are associated with posttraumatic complications in patients with major trauma

“…This massive blood product substitution could contribute to posttraumatic immunological disorders and subsequent MODS [26]. However, in the present study, the volume of transfusion was only correlated with the decrease in cytotoxic loading of NK cells on day seven after trauma, potentially as a result of the cumulative influence of seven days of high volume transfusion [27].…”

Perioperative Systemic Inflammatory Response following Robot-Assisted Laparoscopic Cystectomy vs. Open Mini-Laparotomy Cystectomy: A Prospective Study

“…In our study, the chemokine MCP-1 had the least elevation in RALC-IUD. The lower MCP-1 in the RALC-IUD in our study corresponds well with findings by Jackman et al [30], comparing bleeding and transfusion. They found that MCP-1 had the highest elevation in the bleed and transfused groups.…”

Epidemiology of Acute Transfusions in Major Orthopaedic Trauma

“…16 The immune modulatory effect of trauma and transfusion might influence both wound and bone healing. 17 Potential weakness of our study is the relatively small number of orthopaedic trauma patients. This is not unusual when describing major orthopaedic trauma, especially if describing injury combinations.…”