title: Transfusion-related immunomodulation: review of the literature and implications for pediatric critical illness.
abstract: Transfusion-related immunomodulation (TRIM) in the intensive care unit (ICU) is difficult to define and likely represents a complicated set of physiologic responses to transfusion, including both proinflammatory and immunosuppressive effects. Similarly, the immunologic response to critical illness in both adults and children is highly complex and is characterized by both acute inflammation and acquired immune suppression. How transfusion may contribute to or perpetuate these phenotypes in the ICU is poorly understood, despite the fact that transfusion is common in critically ill patients. Both hyperinflammation and severe immune suppression are associated with poor outcomes from critical illness, underscoring the need to understand potential immunologic consequences of blood product transfusion. In this review we outline the dynamic immunologic response to critical illness, provide clinical evidence in support of immunomodulatory effects of blood product transfusion, review preclinical and translational studies to date of TRIM, and provide insight into future research directions.
authors.affiliation: Division of Critical Care Medicine, Canadian Blood Services, Edmonton, Alberta, Canada.|The Research Institute, Canadian Blood Services, Edmonton, Alberta, Canada.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Muszynski
authors.affiliation: Department of Pediatrics, Division Pediatric Critical Care, Canadian Blood Services, Edmonton, Alberta, Canada.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Spinella
authors.affiliation: Pediatric Critical Care and Cardiology, Canadian Blood Services, Edmonton, Alberta, Canada.
authors.forename: Jill M
authors.initials: JM
authors.lastname: Cholette
authors.affiliation: Centre for Innovation, Canadian Blood Services.|Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Acker
authors.affiliation: Division of Critical Care Medicine, Canadian Blood Services, Edmonton, Alberta, Canada.|The Research Institute, Canadian Blood Services, Edmonton, Alberta, Canada.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Hall
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Nicole P
authors.initials: NP
authors.lastname: Juffermans
authors.affiliation: Division of Critical Care, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Kelly
authors.affiliation: Transfusion Medicine/Blood Bank and Clinical Laboratories, Departments of Pathology and Laboratory Medicine, University of Rochester, Rochester, New York.
authors.forename: Neil
authors.initials: N
authors.lastname: Blumberg
authors.affiliation: Department of Pathology, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Nicol
authors.affiliation: Pediatric Critical Care Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Liedel
authors.affiliation: Departments of Pediatrics and Biochemistry, Washington University in St Louis, St Louis, Missouri.
authors.forename: Allan
authors.initials: A
authors.lastname: Doctor
authors.affiliation: Department of Pediatrics, Division Pediatric Critical Care, Canadian Blood Services, Edmonton, Alberta, Canada.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Remy
authors.affiliation: Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Marisa
authors.initials: M
authors.lastname: Tucci
authors.affiliation: Department of Pediatrics, Sainte-Justine Hospital, Université de Montréal, Montreal, Quebec, Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: Lacroix
authors.affiliation: Blood Systems Research Institute.|Departments of Laboratory Medicine and Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Philip J
authors.identifier: 0000-0003-0526-2088
authors.initials: PJ
authors.lastname: Norris
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016913:Blood Component Transfusion; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D006801:Humans; D056747:Immunomodulation; D007223:Infant; D007249:Inflammation / Q000209:etiology / Q000276:immunology; D007362:Intensive Care Units; D008297:Male