Transfusion-induced anergy: skin test as an index for pretransplant transfusions

Cell-mediated immunity in vivo was studied by delayed cutaneous hypersensitivity (DCH) to seven antigens in 156 chronic haemodialysis (HD) patients, using a disposable multipuncture device. Anergy was found in 46.8 per cent of patients, and a positive correlation was seen between anergy and female sex, time on HD, glomerulonephritis as primary renal disease, younger age and previous blood transfusions (BT). The effect of BT on DCH was studied prospectively in 29 responsive patients. A significant decrease in DCH response was seen. The transfusion-induced anergy remained for a variable time. The pretransplant BT policy suggested by our data would be to periodically undertake skin tests and to transfuse only responsive patients, thereby avoiding the adverse effects of multiple BT.