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Immunologic changes after blood transfusion in patients undergoing vascular surgery
L A Fernandez1, J M MacSween, C K You
1Department of Medicine, Dalhousie University, Camp Hill Medical Center, Halifax, Nova Scotia, Canada.
American Journal of Surgery
|February 1, 1992
Summary
Blood transfusions can cause significant temporary immune system changes, including reduced lymphocyte counts and impaired responses, particularly in patients with cardiovascular disease. These effects were more pronounced in transfused patients compared to non-transfused controls.
Area of Science:
- Immunology
- Transfusion Medicine
- Cardiovascular Surgery
Background:
- Studying immunologic changes after blood transfusions in healthy individuals is ethically challenging.
- Patients with atherosclerotic cardiovascular disease undergoing surgery provide a suitable model to investigate transfusion-related immunomodulation.
- Comparable drug treatment and surgical trauma were maintained between groups to isolate the effects of blood transfusion.
Purpose of the Study:
- To investigate the impact of packed red blood cell transfusions on immune cell populations and function in patients undergoing cardiovascular surgery.
- To compare immunologic parameters between transfused and non-transfused patient groups over an extended postoperative period.
Main Methods:
- Two comparable groups of cardiovascular disease patients were studied: one transfused (average 2.5 units of packed red cells) and one not transfused.
- Immunologic tests were performed preoperatively and at multiple time points postoperatively (5, 10, 45-60, 90, 180, 360 days).
- Assessed parameters included absolute lymphocyte counts (CD3, CD4, CD8, B cells), lymphocyte proliferative responses, T-cell colony formation, immunoglobulin production, and lymphokine production.
Main Results:
- Both groups showed decreased lymphocyte counts postoperatively, but the reduction was significantly greater in the transfused group at 5 days.
- Lymphocyte responses to mitogens and allogeneic cells were reduced in both groups at 5-10 days postoperatively.
- While non-transfused patients showed a rebound increase in lymphocyte response by 60 days, transfused patients did not, with responses becoming comparable by 90-360 days.
- No significant differences were observed in T-cell colony formation, immunoglobulin production, or lymphokine responses between the groups at any time point.
Conclusions:
- Blood transfusions in cardiovascular surgery patients are associated with a significant, albeit temporary, exaggerated decrease in circulating lymphocytes, particularly T-helper cells (CD4+).
- Transfused patients exhibited a delayed or absent rebound in lymphocyte proliferative capacity compared to non-transfused patients.
- These findings highlight transfusion-related immunomodulation and its potential impact on immune recovery following major surgery.