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Vías inflamatorias en la sobrecarga circulatoria asociada a la transfusión
RoseAnn E Vik1, Esther B Bulle2,3, Wilmore C Webley1
1Department of Microbiology, University of Massachusetts Amherst, Amherst, MA.
Blood vessels, thrombosis & hemostasis
|September 2, 2025
Resumen
La sobrecarga circulatoria asociada a la transfusión (TACO, por sus siglas en inglés) puede implicar inflamación, no sólo sobrecarga de líquidos. Se encontraron niveles elevados de citoquinas IL-6 e IL-8 en pacientes con TACO, lo que sugiere que las vías inflamatorias contribuyen a esta complicación de la transfusión.
Área de la Ciencia:
- Medicina para la transfusión
- Inmunología
- Medicina de cuidados intensivos
Sus antecedentes:
- La sobrecarga circulatoria asociada a la transfusión (TACO, por sus siglas en inglés) es una causa importante de mortalidad relacionada con la transfusión.
- Históricamente atribuido a las fuerzas hidrostáticas, la evidencia reciente sugiere que los procesos inflamatorios también pueden desempeñar un papel.
- Comprender la fisiopatología de TACO es crucial para mejorar los resultados de los pacientes.
Objetivo del estudio:
- Investigar la presencia y la extensión de la inflamación en pacientes que experimentan TACO.
- Diferenciar los perfiles inflamatorios entre los casos convencionales de TACO (cTACO) y los casos institucionales de TACO (iTACO).
- Explorar las posibles superposiciones entre el TACO y la lesión pulmonar aguda relacionada con la transfusión (TRALI).
Principales métodos:
- Estudio retrospectivo de tres cohortes de transfusión de glóbulos rojos: cTACO (n=33), iTACO (n=33) y transfusiones sin complicaciones (n=6).
- Análisis de los marcadores inflamatorios séricos (citoquinas, moléculas de adhesión, biomarcadores) antes y después de la transfusión.
- Se recogieron datos clínicos, incluidos los signos vitales y la temperatura, y se compararon entre los grupos.
Principales resultados:
- Los pacientes con cTACO e iTACO presentaron fiebre después de la transfusión, taquicardia y disminución de la saturación de oxígeno.
- Se observaron niveles elevados de citoquinas proinflamatorias IL-6 e IL-8 tanto en el grupo cTACO como en el grupo iTACO.
- La molécula de adhesión intercelular 1 (ICAM-1) fue elevada después de la transfusión específicamente en el grupo iTACO.
Conclusiones:
- Las vías inflamatorias parecen estar involucradas en el desarrollo de TACO.
- El perfil inflamatorio distinto en los pacientes con iTACO sugiere una posible superposición o estado intermedio entre TACO y TRALI.
- Se requiere más investigación para aclarar el papel de la inflamación en la patogénesis de TACO.
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