Transfusion‐related immunomodulation: gamma irradiation alters the effects of leukoreduction on alloimmunization

Nelson, Karen; Aldea, Gabriel S.; Warner, Paul; Latchman, Yvette; Gunasekera, Devi; Tamir, Ayala; Gernsheimer, Terry; Bolgiano, Doug; Slichter, Sherrill J.

doi:10.1111/trf.15555

Cited by 14 publications

(9 citation statements)

References 31 publications

(55 reference statements)

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“…Consistently, in studies that evaluated the side effects of pathogen reduction technology (through UV illumination), gamma‐irradiated products are usually examined as a radiation control comparable to nontreated PLTs 26,27,50,71 . However, given some reports about lower posttransfusion efficacy and safety of gamma‐irradiated PCs 31–33,72 and proteomics‐based studies that highlight higher levels of PSL in these products compared to nonirradiated ones, 29,51 the study presented here for the first time investigated the levels of ROS generation in gamma‐irradiated PCs compared to nonirradiated PLTs. Our research emerges that gamma irradiation can significantly increase cytosolic ROS generation in two different phases, one at an earlier stage upon irradiation and another after longer storage of PLTs.…”

Section: Resultsmentioning

confidence: 99%

The effect of gamma irradiation on platelet redox state during storage

2020

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Background As a method with insignificant adverse effects on in vitro quality of platelet concentrates (PCs), gamma irradiation is applied to abrogate the risk of transfusion‐associated graft‐vs‐host disease in vulnerable recipients. However, there is some evidence of lower posttransfusion responses and proteomic alterations in gamma‐irradiated platelets (PLTs), which raises some questions about their quality, safety, and efficacy. Since reactive oxygen species (ROS) are considered as markers of PLT storage lesion (PSL), the study presented here investigated oxidant state in gamma‐irradiated PCs. Study Design and Methods PLT‐rich plasma PC was split into two bags, one kept as control while other was subjected to gamma irradiation. Within 7 days of storage, the levels of intra‐PLT superoxide, H2O2, mitochondrial ROS, P‐selectin expression, and phosphatidylserine (PS) exposure were detected by flow cytometry while intracellular reduced glutathione (GSH), glucose concentration, and lactate dehydrogenase (LDH) activity were measured by enzymocolorimetric method. Results GSH decreased, while ROS generation and LDH activity increased, during storage. Gamma irradiation significantly attenuated GSH whereas increased ROS generation in earlier and later stages of storage associated with either P‐selectin or PS exposure increments. Conclusion Gamma irradiation can significantly increase cytosolic ROS generation in two distinct phases, one upon irradiation and another later in longer‐stored PCs. While earlier ROS influx seems to be governed by direct effect of irradiation, the second phase of oxidant stress is presumably due to the storage‐dependent PLT activation. Intriguingly, these observations were also in line with early P‐selectin increments and increased PS exposure in longer‐stored PLTs. Given the mutual link between ROS generation and PLT activation, further investigation is required to explore the effect of gamma irradiation on the induction of PSL.

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Section: Resultsmentioning

confidence: 99%

The effect of gamma irradiation on platelet redox state during storage

2020

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“…Compared with allogeneic blood transfusion, ANH autologous blood transfusion is performed by drawing autologous blood before surgery and returning it to the patient during surgery, which not only reduces the loss of red blood cells and platelets during surgery, but also has a short storage time and does not require refrigeration, so the blood components are less damaged, which facilitates the patient's postoperative recovery. CRP, TNF-α, and IL-6 are all key cytokines that initiate inflammatory or immune responses when the body perceives inflammatory stimuli such as trauma ( 17 , 18 ). In this study, 5d after operation, the CRP, TNF-α, and IL-6 of the allogeneic group were higher than those before operation, and the autologous group was lower than that of the allogeneic group ( P < 0.05).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Different Blood Transfusion Methods in Patients Undergoing Cesarean Section

Guo

Tang²,

Wei³

2022

Front. Surg.

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PurposeTo compare the effect of allogeneic transfusion and acute normovolemic hemodilution (ANH) autologous transfusion in patients undergoing cesarean section.MethodsPatients who underwent cesarean section and received blood transfusion therapy from February 2019 to July 2021 in our hospital were observed and divided into the allogeneic group (n = 55) who received allogeneic transfusion therapy and the autologous group (n = 55) who received ANH autologous transfusion therapy according to the mode of transfusion. Observations included vital signs [heart rate (HR), mean arterial pressure (MAP), stroke volume variation (SVV)], blood routine [red blood cells (RBC), platelets (PLT), hematocrit (HCT), hemoglobin (Hb)], T-cell subsets (CD4+, CD8+, CD4+/CD8+), immunoglobulins (IgA, IgM, IgG), inflammatory factors [C-reactive protein (CRP), tumor necrosis factor (TNF)-α, interleukin (IL)-6], and adverse effects were counted in both groups.ResultsThere was no statistical significance in the intra-group and inter-group comparisons of HR, MAP, and SVV between the two groups before transfusion and transfusion for 10 min (P > 0.05). 5d after operation, the RBC, PLT, HCT, and Hb of the allogeneic group were lower than those before operation, and the autologous group was higher than that of the allogeneic group (P < 0.05). 5d after operation, the CRP, TNF-α, and IL-6 of the allogeneic group were higher than those before operation, and the autologous group was lower than that of the allogeneic group (P < 0.05). 5d after operation, the CD4+, CD4+/CD8+ of the allogeneic group were lower than before operation, and the CD8+ was higher than before operation. The CD4+ and CD4+/CD8+ of the autologous group were higher than that of the allogeneic group, and CD8+ was lower than that of the allogeneic group (P < 0.05). 5d after operation, the IgA, IgG, and IgM of the allogeneic group were lower than those before operation, and the autologous group was higher than that of the allogeneic group (P < 0.05). During blood transfusion, there was no significant difference in the adverse reaction rate between the two groups (P > 0.05).ConclusionBoth allogeneic transfusion and ANH autologous transfusion have little effect on the vital signs of patients undergoing cesarean section, but ANH autologous transfusion is more helpful to the stability of blood routine, T-cell subsets, immunoglobulin, and inflammation levels after surgery, which is a safe and effective way of blood transfusion.

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“…As previously mentioned, leukoreduction may decrease HLA alloimmunization risk, but the risk varies with underlying diagnosis, history of pregnancy, and transfusion exposures. 33,36 Nonimmune causes of platelet refractoriness include sepsis, splenomegaly, disseminated intravascular coagulation, and medications. 37 Once nonimmune causes are excluded, a platelet antibody screen should be performed to evaluate plateletrefractory patients.…”

Section: Modern Applications Of Directed Donationmentioning

confidence: 99%

Directed Donation: Special Considerations and Review for Contemporary Clinical Practices

Wadge¹,

Zhang

Seal

et al. 2021

TOJ

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Background: Directed blood donation is defined as the donation of blood or its components for the purpose of transfusion into a specified individual. Directed blood donation holds historic significance, and although practices as of 2021 encourage voluntary, nonrenumerated blood donations, public interest in directed donation remains. Requests to discuss the risks and benefits of directed donations are a common inquiry for transfusion medicine, transplant, and hematology/oncology professionals. This narrative review discusses the history of directed donation and summarizes directed donation considerations in the context of modern transfusion practices. Methods: We conducted a systematic search of PubMed for published literature on the topic of directed blood donation and gathered information about its benefits and potential harms with respect to the variety of products used in transfusion medicine. Results: The drawbacks of directed donation include transfusion-transmitted infection risk, alloimmunization risk, increased transfusion-associated graft vs host disease risk, decreased expediency in treatment, and increased administrative burdens. However, a role remains for directed blood donation in specific patient populations, such as individuals with rare blood types or immunoglobulin A deficiencies, because of the difficulties in finding compatible blood for transfusion. Conclusion:Clinicians should consider the risks and benefits when discussing directed blood donations with patients and family members.

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Transfusion‐related immunomodulation: gamma irradiation alters the effects of leukoreduction on alloimmunization

Cited by 14 publications

References 31 publications

The effect of gamma irradiation on platelet redox state during storage

The effect of gamma irradiation on platelet redox state during storage

Comparison of Different Blood Transfusion Methods in Patients Undergoing Cesarean Section

Directed Donation: Special Considerations and Review for Contemporary Clinical Practices

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