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Allogeneic red cell transfusion and its influence on relevant humoral and cellular immunological parameters

A prospective observational trial

Suksompong, Sirilak; Tassaneetrithep, Boonrat; Ariyawatkul, Thanase; Sirivanasandha, Busara; Wilartratsami, Sirichai; Wongsa, Artit; von Bormann, Benno

European Journal of Anaesthesiology (EJA): November 2019 - Volume 36 - Issue 11 - p 814–824
doi: 10.1097/EJA.0000000000001027

BACKGROUND It is assumed that transfusion of allogeneic red cells is associated with increased peri-operative mortality and morbidity. Also assumed is the theory of transfusion-related immunomodulation.

OBJECTIVE The aim of this study was to investigate the hypothesis that red cell transfusion specifically leads to an immunological response in surgical patients.

DESIGN Prospective observational study.

SETTING Departments of Orthopedic Surgery and Anaesthesia, University Hospital, Thailand.

PATIENTS Low-risk, noncancer patients, aged 18 to 75 years undergoing elective major spine surgery, with and without red cell transfusion therapy.

INTERVENTIONS Blood specimens were withdrawn four times (prior to surgery and on days 1, 3 and 5).

MAIN OUTCOME MEASURES Assessment of immunocompetent cells and cytokines in transfused and nontransfused patients using flow cytometry and multiplex ELISA.

RESULTS From a total of 78 patients, 61 met the requirements and were analysed in three groups: 19 with no transfusion and 26 and 16 transfused intra-operatively and on day 1 or 2, respectively. No patient experienced peri-operative haemorrhage. Postoperative infection or thrombosis occurred in 5.5% of nontransfused patients and 16.6% of transfused patients; the difference was not significant. There was no significant immunomodulatory effect of red cell transfusion: of 45 immunological parameters, only five little-relevant cytokines were significantly affected, although slightly and nonspecifically.

CONCLUSION Our data indicate that red cell transfusion alone does not create an immunological response in otherwise healthy surgical patients. Our findings do not generally contradict the transfusion-related immunomodulation phenomenon, which has, however, primarily been observed in patients with an already weakened or procedure-deteriorated immune system, such as from malignant disease, significant comorbidity, extensive abdominal/thoracic surgery and cardiopulmonary bypass.

TRIAL REGISTRATION The study was registered on 15 May 2014, before enrolment of the first patient, at, NCT02140216.

From the Department of Anesthesiology (SS, BS, BvB), Centre of Research Excellence in Immunoregulation (BT, AW) and Department of Orthopedic Surgery (TA, SW), Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

Correspondence to Benno von Bormann, Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok 10700, Thailand Tel: +66 918825723/+66 24197990; e-mail:

Published online 30 May 2019

© 2019 European Society of Anaesthesiology