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Related Experiment Videos

Transfusion immunomodulation or TRIM: what does it mean clinically?

M A Blajchman1

  • 1Department of Pathology, Canadian Blood Services Hamilton, McMaster University, Ontario, Canada. blajchma@mcmaster.ca

Hematology (Amsterdam, Netherlands)
|September 29, 2005
PubMed
Summary

Allogeneic blood transfusions can cause transfusion-associated immunomodulation (TRIM), potentially increasing risks for recipients. Leukoreduction of blood products may mitigate these harmful effects, improving patient outcomes.

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Area of Science:

  • Transfusion Medicine
  • Immunology
  • Clinical Pathology

Background:

  • Allogeneic blood transfusions are known to induce immunosuppression in recipients, a phenomenon termed transfusion-associated immunomodulation (TRIM).
  • TRIM has been associated with both improved outcomes in renal transplantation and potentially negative effects like increased cancer recurrence and post-operative infections.
  • The clinical significance and risks of TRIM remain a significant concern in Transfusion Medicine.

Purpose of the Study:

  • To investigate the evidence for clinically significant immunosuppression and other effects of allogeneic blood transfusions.
  • To evaluate the association between TRIM and adverse outcomes such as cancer recurrence, infection, mortality, and organ dysfunction.
  • To explore the role of leukocyte-containing blood products and the potential benefits of leukoreduction.

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Main Methods:

  • Review of evidence from various sources, including randomized controlled trials and experimental animal studies.
  • Analysis of recent large observational trials examining the effects of leukocyte-containing allogeneic cellular blood products.

Main Results:

  • While randomized trials have not definitively proven TRIM's link to cancer recurrence or infection, animal studies suggest it's an immune effect mediated by leukocytes, preventable by leukoreduction.
  • Recent observational studies indicate that leukocyte-containing allogeneic blood products are associated with increased risks of mortality and organ dysfunction.
  • The potential for TRIM to increase morbidity and mortality in transfused individuals is a growing concern.

Conclusions:

  • TRIM is a biologically plausible effect of allogeneic transfusions, particularly those containing leukocytes.
  • Pre-storage leukoreduction of blood products shows promise in ameliorating deleterious TRIM-associated effects.
  • Further research is needed to fully elucidate the risks and benefits of TRIM, but current evidence suggests caution with leukocyte-containing transfusions.