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Published on: September 6, 2017
Blood transfusion is associated with donor leukocyte microchimerism in trauma patients
Garth H Utter1, John T Owings, Tzong-Hae Lee
1Department of Surgery, University of California, Davis, Medical Center, Blood Centers of the Pacific, San Francisco, California 95817, USA.
Introduction:
Blood transfusion can result in survival of donor leukocyte subpopulations in the recipient. Persistence of donor leukocytes in the transfusion recipient is termed microchimerism. Microchimerism likely reflects engraftment of the recipient with donor hematopoietic stem cells and is very uncommon with transfusion for elective surgery, sickle cell anemia, thalassemia, and HIV. We have found, however, that microchimerism may be more common in trauma patients.
Objective:
To determine how frequently transfusion after trauma is associated with microchimerism.
Methods:
We prospectively enrolled 45 trauma patients who were transfused > or =2 units of PRBCs. We sampled blood before hospital discharge and determined microchimerism by polymerase chain reaction (PCR) analysis of specimens using quantitative allele-specific HLA DR assays to detect non-recipient alleles. Data are expressed as median with interquartile range.
Results:
Patients had a median age of 38 (interquartile range 25, 58) years, ISS of 19 (13, 29), and mortality of 7%. Seventy-eight percent were men, and 84% had blunt trauma. Patients received a median of 6 (4, 16) (range 2, 87) units of PRBCs. Of the 45 patients, 24 (53%) had evidence of microchimerism. Compared with patients without evidence of microchimerism, these patients had no difference in mean age, gender, ISS, units of PRBCs transfused, time from transfusion to blood sampling, or proportion that underwent splenectomy. Twenty-one of the 24 patients with microchimerism had only 1 or 2 non-recipient DR alleles identified by PCR.
Conclusions:
Transfusion after trauma is associated with over half of recipients having evidence of microchimerism. Age, sex, ISS, and splenectomy of the recipient and the number of transfused units did not correlate with microchimerism. Because the median time from transfusion to sampling for PCR analysis was not longer in the group without microchimerism, it is unlikely microchimerism is due merely to failure of the recipient to clear transfused donor leukocytes.
Insights
Microchimerism, the survival of donor leukocytes after blood transfusion, is common in trauma patients. Over half of trauma patients receiving transfusions showed microchimerism, suggesting it
Area of Science:
- Immunology
- Transfusion Medicine
- Trauma Surgery
Background:
- Blood transfusions can lead to the survival of donor leukocytes in recipients, a phenomenon known as microchimerism.
- Microchimerism, indicative of donor hematopoietic stem cell engraftment, is rare in transfusions for elective surgery, sickle cell anemia, thalassemia, and HIV.
- Trauma patients may exhibit a higher incidence of microchimerism following blood transfusions.
Purpose of the Study:
- To investigate the frequency of microchimerism in patients who have received blood transfusions after trauma.
- To determine the association between transfusion and microchimerism in trauma survivors.
Main Methods:
- Prospective enrollment of 45 trauma patients who received at least 2 units of packed red blood cells (PRBCs).
- Blood samples collected before hospital discharge for polymerase chain reaction (PCR) analysis.
- Quantitative allele-specific HLA DR assays used to detect non-recipient alleles, indicating microchimerism.
Main Results:
- Microchimerism was detected in 24 out of 45 (53%) trauma patients.
- No significant differences were observed in age, gender, Injury Severity Score (ISS), units of PRBCs transfused, or splenectomy status between patients with and without microchimerism.
- The majority of patients with microchimerism (21/24) showed only one or two non-recipient DR alleles.
Conclusions:
- Transfusion in trauma patients is frequently associated with microchimerism, occurring in over half of recipients.
- Recipient factors such as age, sex, ISS, splenectomy, and the number of transfused units did not correlate with microchimerism.
- The persistence of microchimerism is unlikely due to a failure to clear transfused donor leukocytes, as sampling times did not differ significantly.
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