Effect of autologous salvaged blood on postoperative natural killer cell precursor frequency

Gharehbaghian, Ahmad; Haque, K.M.G.; Truman, Carol; Evans, R.; Morse, Ruth; Newman, John H.; Bannister, G.C.; Rogers, Chris; Bradley, Benjamin A.

doi:10.1016/s0140-6736(04)15837-6

Cited by 70 publications

(66 citation statements)

References 28 publications

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“…S5) [20]. In this study, these changes are shown to be accompanied by increases in the proinflammatory biomarkers annexin-A2, IL-1β, IL-2, IL-17A, IFN-γ and TNF-α, and decreases in the anti-inflammatory biomarkers IL-4, IL-5, IL-10 and IL-13.…”

Section: Discussionsupporting

confidence: 49%

“…All patients in the NSBT and ASBT cohorts showed similar post-operative trends in the haematological biomarkers (an exception being NKp cell levels published elsewhere [20]). These included above-normal levels of neutrophils and monocytes …”

Section: Common Biomarkers Of Sterile Traumasupporting

confidence: 53%

“…1). Similar to our previous study, all patients had a subcutaneous drain inserted into their wound site which was attached to a Dideco-797 Recovery Device (Sorin Group Ltd, Milan, Italy) through which negative pressure was applied [20].…”

Section: Methodsmentioning

confidence: 98%

“…This was exacerbated by allogeneic or pre-deposited autologous blood transfusions. However, reinfusion of unwashed anticoagulated salvaged blood caused NKp cells to rise above preoperative levels, accompanied by enhanced interferon (IFN)-γ synthesis and macrophage activation, suggesting that PTI had been reversed [20,23]. This was supported by studies from others showing enhanced post-operative immunity following reinfusion of fresh anti-coagulated autologous blood [24,25].…”

Section: Introductionmentioning

confidence: 99%

“…Accompanying these changes is a decrease in circulating basophil, eosinophil and natural killer precursors (NKp), which further weakens systemic immunity [20]. Sterile SIRS is clinically indistinguishable from infected SIRS, but differences exist in their gene expression profiles [21].…”

Section: Introductionmentioning

confidence: 99%

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Post-traumatic immunosuppression is reversed by anti-coagulated salvaged blood transfusion: deductions from studying immune status after knee arthroplasty

Islam

Whitehouse

Mehendale

et al. 2014

Clinical and Experimental Immunology

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SummaryMajor trauma increases vulnerability to systemic infections due to poorly defined immunosuppressive mechanisms. It confers no evolutionary advantage. Our objective was to develop better biomarkers of post-traumatic immunosuppression (PTI) and to extend our observation that PTI was reversed by anti-coagulated salvaged blood transfusion, in the knowledge that others have shown that non-anti-coagulated (fibrinolysed) salvaged blood was immunosuppressive. A prospective non-randomized cohort study of patients undergoing primary total knee arthroplasty included 25 who received salvaged blood transfusions collected post-operatively into acid-citrate-dextrose anti-coagulant (ASBT cohort), and 18 non-transfused patients (NSBT cohort). Biomarkers of sterile trauma included haematological values, damage-associated molecular patterns (DAMPs), cytokines and chemokines. Salvaged blood was analysed within 1 and 6 h after commencing collection. Biomarkers were expressed as fold-changes over preoperative values. Certain biomarkers of sterile trauma were common to all 43 patients, including supranormal levels of: interleukin (IL)-6, IL-1-receptor-antagonist, IL-8, heat shock protein-70 and calgranulin-S100-A8/9. Other proinflammatory biomarkers which were subnormal in NSBT became supranormal in ASBT patients, including IL-1β, IL-2, IL-17A, interferon (IFN)-γ, tumour necrosis factor (TNF)-α and annexin-A2. Furthermore, ASBT exhibited subnormal levels of anti-inflammatory biomarkers: IL-4, IL-5, IL-10 and IL-13. Salvaged blood analyses revealed sustained high levels of IL-9, IL-10 and certain DAMPs, including calgranulin-S100-A8/9, alpha-defensin and heat shock proteins 27, 60 and 70. Active synthesis during salvaged blood collection yielded increasingly elevated levels of annexin-A2, IL-1β, Il-1-receptor-antagonist, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-17A, IFN-γ, TNF-α, transforming growth factor (TGF)-β1, monocyte chemotactic protein-1 and macrophage inflammatory protein-1α. Elevated levels of high-mobility group-box protein-1 decreased. In conclusion, we demonstrated that anti-coagulated salvaged blood reversed PTI, and was attributed to immune stimulants generated during salvaged blood collection.

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Section: Discussionsupporting

confidence: 49%

Section: Common Biomarkers Of Sterile Traumasupporting

confidence: 53%

Section: Methodsmentioning

confidence: 98%