Immunologic changes after transfusion of autologous or allogeneic buffy coat-poor versus white cell-reduced blood to patients undergoing arthroplasty. I. Proliferative T-cell responses and the balance of helper and suppressor T cells.
BACKGROUND
Donor white cells (WBCs) contained in red cell (RBC) transfusions are thought to provoke down-regulation of T-cell-mediated immunity. This study investigated this topic in otherwise healthy patients receiving buffy coat-depleted or WBC-filtered RBCs and undergoing standardized perioperative management.


METHODS
Patients undergoing elective orthopedic surgery (primary hip and knee replacement surgery) were enrolled in a prospective study. Perioperative changes in T-cell proliferation (stimulation with phytohemagglutinin and mixed lymphocyte culture) and T-cell balance (T-lymphocytes, helper T cells, and suppressor T cells) were compared after random assignment to allogeneic buffy coat-depleted (Group 2, n = 8) or WBC-reduced RBC (Group 3, n = 11) transfusion regimens. Recipients of autologous buffy coat-depleted RBC transfusions (n = 15) served as controls (Group 1).


RESULTS
Compared to that in autologous transfusion recipients, alloantigen-induced T-cell proliferation was significantly reduced in recipients of allogeneic WBC-reduced RBCs (Day 3, p = 0.0274). After the transfusion of allogeneic buffy coat-depleted RBCs, a weak trend toward decreased T-cell proliferation was observed (p = 0.0933) and the numbers of CD4+ T cells were also significantly lower (Day 7, p = 0.0389). On Day 10, alloantigen-induced T-cell proliferation remained significantly below baseline after transfusion of WBC-reduced RBCs (p = 0.05), the numbers of CD3+ cells decreased in allogeneic RBC recipients (Group 2, p = 0.078; Group 3, p = 0.05), and those of CD8+ cells decreased significantly after the transfusion of allogeneic buffy coat-depleted RBCs (p = 0.0234) concomitant with an increased CD4:CD8 ratio (p = 0.0391).


CONCLUSIONS
Results of the present study confirm the hypothesis of impaired T-cell-mediated immunity after allogeneic transfusion.
Innerhofer
P
P
Department of Anesthesia and Intensive Care, Computer Center, University of Innsbruck, Austria. Petra.Innerhofer@uibk.ac.at
Luz
G
G
Spötl
L
L
Hobisch-Hagen
P
P
Schobersberger
W
W
Fischer
M
M
Nussbaumer
W
W
Lochs
A
A
Irschick
E
E
D001178:Arthroplasty; D001781:Blood Component Removal; D001804:Blood Transfusion, Autologous / Q000009:adverse effects*; D017252:CD3 Complex / Q000032:analysis; D016516:CD4-CD8 Ratio; D018414:CD8-Positive T-Lymphocytes / Q000473:pathology; D002455:Cell Division; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D006801:Humans; D007111:Immunity, Cellular; D007231:Infant, Newborn; D007937:Leukapheresis; D011183:Postoperative Complications; D011446:Prospective Studies; D013601:T-Lymphocytes / Q000276:immunology / Q000473:pathology*; D006377:T-Lymphocytes, Helper-Inducer / Q000473:pathology*; D050378:T-Lymphocytes, Regulatory / Q000473:pathology*
D017252:CD3 Complex