title: The impact of two different transfusion strategies on patient immune response during major abdominal surgery: a preliminary report.
abstract: Blood transfusion is associated with well-known risks. We investigated the difference between a restrictive versus a liberal transfusion strategy on the immune response, as expressed by the production of inflammatory mediators, in patients subjected to major abdominal surgery procedures. Fifty-eight patients undergoing major abdominal surgery were randomized preoperatively to either a restrictive transfusion protocol or a liberal transfusion protocol (with transfusion if hemoglobin dropped below 7.7 g dL(-1) or 9.9 g dL(-1), respectively). In a subgroup of 20 patients randomly selected from the original allocation groups, blood was sampled for measurement of IL-6, IL-10, and TNFα. Postoperative levels of IL-10 were higher in the liberal transfusion group on the first postoperative day (49.82 ± 29.07 vs. 15.83 ± 13.22 pg mL(-1), P < 0.05). Peak postoperative IL-10 levels correlated with the units of blood transfused as well as the mean duration of storage and the storage time of the oldest unit transfused (r(2) = 0.38, P = 0.032, r(2) = 0.52, P = 0.007, and r(2) = 0.68, P<0.001, respectively). IL-10 levels were elevated in patients with a more liberal red blood cell transfusion strategy. The strength of the association between anti-inflammatory IL-10 and transfusion variables indicates that IL-10 may be an important factor in transfusion-associated immunomodulation. This trial is registered under ClinicalTrials.gov Identifier: NCT02020525.
authors.affiliation: Department of Anesthesiology, Aretaieion University Hospital, 11528 Athens, Greece.
authors.forename: Kassiani
authors.identifier: 0000-0003-4890-4642
authors.initials: K
authors.lastname: Theodoraki
authors.affiliation: Department of Anesthesiology, Aretaieion University Hospital, 11528 Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Markatou
authors.affiliation: Hormonal and Biochemical Laboratory, Aretaieion University Hospital, 11528 Athens, Greece.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Rizos
authors.affiliation: Department of Anesthesiology, Aretaieion University Hospital, 11528 Athens, Greece.
authors.forename: Argyro
authors.initials: A
authors.lastname: Fassoulaki
mesh_terms: D000005:Abdomen / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D001803:Blood Transfusion / Q000379:methods*; D006801:Humans; D007113:Immunity, Innate; D007249:Inflammation / Q000097:blood / Q000276:immunology / Q000473:pathology; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; C508609:IL10 protein, human; C508600:IL6 protein, human; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10