Comparison of effects of allogeneic blood transfusion and hemodiluted autotransfusion on cellular immune function in patients undergoing cesarean section

Abstract

Objective To compare the effects of allogeneic blood transfusion and hemodiluted autotransfusion on cellular immune function in the patients undergoing cesarean section. Methods Sixty patients, aged 20-35 yr, weighing 50-80 kg, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for elective cesarean section, were randomly divided into 2 groups(n = 30 each)using a random number table: hemodiluted autotransfusion group(group HAT)and allogeneic blood transfusion group(group ABT). Both groups received epidural anesthesia.The radial artery was cannulated after epidural anesthesia, and the autologous blood was collected in group HAT.The autologous blood transfusion timing: intraoperative blood loss was expected to exceed 20% of blood volume.For the patients in whom intraoperative blood loss was not expected to exceed 20% of blood volume, bleeding was stopped, and autologous blood was infused intravenously after peritoneum closure.The allogeneic blood transfusion timing: when hemoglobin 1.5 times of the normal value, the fresh frozen plasma 100-400 ml was infused intravenously; when platelet count<50×109/L, platelets 10-40 U were infused intravenously.When entering the operating room(T0), on 1st day after operation(T1), and on 5th day after operation(T2), blood samples were collected to detect the levels of T lymphocyte subsets CD3+ , CD4+ and CD8+ (using FACScan flow cytometer), and serum interleukin-2(IL-2)and IL-6 concentrations(by enzyme-linked immunosorbent assay). CD4+ /CD8+ ratio was calculated. Results Compared with the values at T0, the levels of CD3+ and CD4+ , CD4+ /CD8+ ratio, and serum IL-2 concentrations were significantly decreased, and the serum IL-6 concentrations were increased at T1, 2 in group ABT, and at T1 in group HAT(P<0.05). Compared with group ABT, the CD3+ and CD4+ levels, CD4+ /CD8+ ratio and serum IL-6 concentrations were significantly increased at T1, and the serum IL-2 concentrations were increased at T1, 2 in group HAT(P<0.05). Conclusion Compared with allogeneic transfusion, hemodiluted autotransfusion has less inhibitory effect on cellular immune function in the patients undergoing cesarean section. Key words: Blood transfusion, autologous; Blood component transfusion; Cesarean section; Immunity, cellular