title: Shed Pleural Blood from Traumatic Hemothorax Contains Elevated Levels of Pro-Inflammatory Cytokines.
abstract: The autotransfusion of unwashed (or unprocessed) shed hemothorax blood (USHB) in trauma patients is widely assumed to be beneficial; however, the inflammatory potential of shed pleural blood has not been thoroughly studied. Since previous studies have documented marked changes in coagulation function of shed pleural blood, we hypothesized that its level of inflammatory cytokines would be elevated.
  
  
  
  A prospective observational study of trauma patients in whom cytokine levels from USHB were compared to venous samples from healthy volunteers was conducted. Differences between the cytokine content of patient-derived samples were compared to those from healthy subjects.
  
  
  
  There was a statistically significant increase in pro-inflammatory cytokines (IL-6, IL-8, TNFα, GM-CSF), a pro-inflammatory Th-1 cytokine (IFNγ), and anti-inflammatory Th-2 cytokines (IL-4 and IL-10) in shed pleural blood over four hours when compared with samples from healthy controls (P <0.05). Cytokine levels in USHB are approximately 10- to 100-fold higher compared with healthy control venous samples.
  
  
  
  USHB, even collected within the accepted four-hour window, contains significantly elevated cytokine levels, suggesting the potential for deleterious effects from autotransfusion. Randomized trials are needed to determine the safety and efficacy of autotransfusion in trauma patients.
authors.affiliation: *Division of Trauma and Emergency Surgery, Department of Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas †United States Army Institute of Surgical Research, Fort Sam Houston, Texas.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Salhanick
authors.forename: Valere G
authors.initials: VG
authors.lastname: Sams
authors.forename: Heather F
authors.initials: HF
authors.lastname: Pidcoke
authors.forename: Chriselda G
authors.initials: CG
authors.lastname: Fedyk
authors.forename: Michael R
authors.initials: MR
authors.lastname: Scherer
authors.forename: Michael A
authors.initials: MA
authors.lastname: Dubick
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Dent
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Cap
authors.forename: Martin G
authors.initials: MG
authors.lastname: Schwacha
mesh_terms: D000328:Adult; D001804:Blood Transfusion, Autologous / Q000009:adverse effects; D016207:Cytokines / Q000097:blood*; D005260:Female; D006491:Hemothorax / Q000097:blood*; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D015847:Interleukin-4 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013898:Thoracic Injuries / Q000097:blood* / Q000276:immunology*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D014947:Wounds and Injuries / Q000097:blood* / Q000276:immunology*
chemical_list: D016207:Cytokines; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D015847:Interleukin-4