title: Transfusion of blood products and nosocomial infection in surgical patients.
abstract: OBJECTIVE
  Liberal transfusion of blood products may be associated with a worse clinical outcome, including in-hospital mortality. This review focuses on the mechanisms by which transfusions may result in an increased risk of bacterial infection.
  
  
  RESULTS
  The association between blood transfusion and worse outcome has been attributed to suppression of the recipient's immune function, the so called transfusion-related immunomodulation effect, as well as changes that may occur as blood ages. Despite several attempts to identify the mechanism by which transfusion worsens outcomes, this mechanism, as well as the role of leukoreduction in the mitigation of transfusion-related immunomodulation, have yet to be demonstrated. Bacterial contamination of the blood supply has become a serious problem in the past 20 years, and is currently the second leading cause of transfusion-associated death. Since the implementation of specific platelet transfusion protocols, the incidence of morbidity and mortality caused by infected platelet units appears to be markedly reduced.
  
  
  CONCLUSIONS
  Transfusion of blood and blood products can be life-saving interventions. Consequences of transfusion may ultimately result in worse outcomes. More research will be required in order to identify indications and practices that optimize outcomes of surgical patients who require a blood transfusion.
authors.affiliation: Department of Surgery, Division of Burn/Trauma/Critical Care, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9158, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Gunst
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Minei
mesh_terms: D003428:Cross Infection / Q000097:blood* / Q000209:etiology; D013502:General Surgery; D006801:Humans; D018570:Risk Assessment; D012308:Risk Management; D065227:Transfusion Reaction; D014481:United States