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Abstract
Blood transfusions remain common practice in the critical care and surgical settings. Transfusions carry significant risks, including risks for transmission of infectious agents and immune suppression. Transmission of bacterial infections, although rare, is the most common adverse event with transfusion. The risk for transmission of viral infections has decreased over time, clearly because tests are becoming more sensitive in detecting certain viral infections such as hepatitis B, hepatitis C, and HIV. Several immunomodulatory effects are thought to be related to transfusions, and these can result in cancer recurrence, mortality, and postoperative infections. Numerous studies have been performed to examine the role of leukoreduction in decreasing these transfusion-related complications but results remain contradictory. We review the infectious risks associated with blood transfusion and the most recent data on its immunologic effects, specifically on cancer recurrence, mortality, and postoperative infections in surgical patients. We also review the use of leukoreduction in blood transfusion and its role in preventing transfusion-transmitted infections and immunomodulatory complications.
Highlights
Blood transfusion remains a common event in current medical practice
We review the use of leukoreduction in blood transfusion and its role in preventing transfusion-transmitted infections and immunomodulatory complications
Increased donor selection criteria and increased screening of donated blood have led to a decrease in the rate of transfusion-related infections
Summary
Blood transfusion remains a common event in current medical practice. Between 10 and 14 million units of blood are donated annually in the USA, and 3–4 million people receive blood transfusions every year [1,2]. This article reviews the infectious risks associated with blood transfusion and analyzes the most recent data on its immunologic effects, on cancer recurrence, mortality, and postoperative infections in surgical patients. Two studies conducted by Jensen and coworkers [40,41] showed a significantly increased risk for postoperative infection with non-WBC-reduced blood transfusion. They evaluated the rate of SSI in patients undergoing colorectal surgery. Patients who received WBC reduced transfusions had no SSIs whereas the control group developed significantly more infectious complications (18.3%) This was a prospective and randomized study; it has been criticized for having uncontrolled confounding factors, giving non-leukoreduction an implausible cause–effect association in the risk for SSI. Mortality and postoperative infections still remain the most attractive reasons to implement this practice, but to date there is not enough evidence to support this practice when based solely on those two effects and further studies are needed
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