Transfusion-related immunomodulation refers to the transient depression of the
immune systemfollowing transfusion of blood products. This effect has been recognized in groups of individuals who have undergone kidney transplantationor have had multiple miscarriages. [Gatenby PA, Cameron K, Simes RJ, Adelstein S, Bennett MJ, Jansen RP, Shearman RP, Stewart GJ, Whittle M, Doran TJ. "Treatment of recurrent spontaneous abortion by immunization with paternal lymphocytes: results of a controlled trial." Am J Reprod Immunol. 1993 Mar;29(2):88-94. PMID 8329110] Some research studies have shown that, because of this immune depression, blood transfusions increase the risk of infections and cancerrecurrence. However, other studies have not shown these differences and the degree of impact transfusion has on infection and tumor recurrence is not well understood. [Goodnough LT, Brecher ME, Kanter MH, AuBuchon JP. "Transfusion medicine. First of two parts--blood transfusion." N Engl J Med. 1999 Feb 11;340(6):438-47. Review. PMID 9971869] The Blood Products Advisory Committee of the Food and Drug Administrationrecommends that all transfused blood products undergo leukocyte reduction in order to offset the contribution of donor white blood cells to immune suppression. [American Association of Blood Banks. "BPAC recommends universal leukoreduction." AABB News Briefs 1998;20(11):16.]
The topic of transfusion immunomodulation (the "related" is redundant and thus unnecessary) is actually of considerably greater importance in medicine and broader in scope than one might think. With the exception of life threatening hemorrhage, the only convincing evidence for the benefit of transfusion therapy as currently practiced is in preventing recurrent stroke in sickle cell disease. The rest of medical uses of transfusion remain of uncertain benefit to risk ratio. What has been definitively demonstrated is that in most clinical situations, the patients who are transfused do considerably worse than those not transfused and those who get more transfusions almost always do worse than those getting fewer transfusions. While some of this effect is due to ascertainment bias (sicker patients get transfused or receive more transfusions), the cause and effect nature of these observations is virtually certain. Some of the effects demonstrating some or all the conditions for cause and effect (dose dependence, reproducibility, biologic plausibility, etc.) include increased post-operative infections (ameliorated in part by leukoreduction or use of autologous transfusions in randomized trials), increased allograft survival, decreased spontaneous abortions, decreased severity of inflammatory bowel disease, increased acute lung injury, increased myocardial infarction and other thrombotic complications, etc. Thus transfusion immunomodulation has been broadened to encompass not only decreases in cellular adaptive immunity but inappropriate activation of innate inflammatory immunity and the hemostatic system, including platelets. Fortunately, some of these effects can in part be mitigated by leukoreduction of blood transfusions or avoidance of blood transfusions. Additional promising preliminary research demonstrates that removal of supernatant plasma from stored transfusions may have beneficial effects. Clearly there are both cells and small molecule biologic mediators in stored donor blood that modulate not only recipient immune function, but hemostatic and organ specific functions. This is one of the more important research agendas in transfusion medicine in terms of clinical outcomes for patients, which has been recognized by the NIH directing its research funds into this area of research beginning in 2008.
For a recent history of this subject, see the commentary below.
Blumberg N.Deleterious clinical effects of transfusion immunomodulation: proven beyond a reasonable doubt.Transfusion. 2005 Aug;45(2 Suppl):33S-39S.
Wikimedia Foundation. 2010.
Look at other dictionaries:
List of oncology-related terms — This is a list of terms related to oncology. The original source for this list was the U.S. National Cancer Institute s public domain Dictionary of Cancer Terms . NOTOC 1 * 10 propargyl 10 deazaaminopterin * 12 O tetradecanoylphorbol 13 acetate * … Wikipedia
Trim — may refer to:Places* Trim, County Meath, a town and castle in Ireland * Trim Station (OC Transpo), a bus station in Ottawa, Canada * Trim Road, in Ottawa, CanadaDecoration* Trim (sewing), ornaments applied to clothing or other textiles * Trim… … Wikipedia
Intraoperative blood salvage — Intraoperative blood salvage, also known as autologous blood salvage, is a medical procedure involving recovering blood lost during surgery and re infusing it into the patient.It has been used for many years and gained greater attention over time … Wikipedia
Simone Mayer — (* 18. Mai 1920 in Metz; † 6. Oktober 2006 in Straßburg; geb. Bloch) war eine französische Hämatologin und Hochschullehrerin. Leben Simone Mayer war Professorin für Hämatologie an der medizinischen Fakultät der Universität Straßburg … Deutsch Wikipedia
Simone Mayer — Simone Mayer. Simone Mayer, née Bloch, née le 18 mai 1920 à Metz et morte le 6 octobre 2006 à Strasbourg, est un médecin français. Biographie Simone Mayer a été professeur d hématologie à la faculté de médecine de Strasbourg … Wikipédia en Français