Transfusion-Associated Immunomodulation: Experimental Facts and Clinical Reality – New Perspectives

Abstract

Blood component transfusion may be required in association with emergency and chronic disease to improve hemodynamics and tissue oxygenation. Due to the risk of microbial transfection from donor to recipient, the blood is undergoing vigorous testing to improve safety. It is well known, however, that blood component transfusion may lead to certain acute side effects with a frequency of 0.5-2% depending on the specific component transfused. In addition, homologous blood component transfusion seems to be associated with increased frequency of bacterial infectious complication after operation in a variety of diseases. If patients have been operated on for malignant diseases, emerging evidence has accumulated that suggests a combination of blood component transfusion, postoperative bacterial infectious complications and subsequent poor longterm survival even in patients who have been curatively resected. The mechanisms leading to such side effects are not known in detail, but bioactive substance accumulation during preparation and storage may play an important role. Such substances may also explain why side effects are also observed after autologous blood transfusion. Institution of universal leukofiltration in most European countries has led to improvement in patient treatment, with reduction of a variety of side effects. Future research should be focused on patient genetic polymorphisms that may play a role in the development of side effects to blood component transfusion.