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.
Highlights
Major abdominal surgery can often be complicated by massive hemorrhage with all the sequelae that profound anemia entails in this setting [1]
The main finding of this secondary post hoc analysis was the higher level of IL-10 24 hours postoperatively in the group that received more blood transfusions intraoperatively and postoperatively in comparison to the restrictive transfusion group
Peak postoperative IL-10 levels were found to correlate with the units of blood transfused as well as the mean duration of storage and the storage time of the oldest unit transfused
Summary
Major abdominal surgery can often be complicated by massive hemorrhage with all the sequelae that profound anemia entails in this setting [1]. Blood transfusion is considered a cornerstone of perioperative care practice and is used to augment oxygen delivery in the hope of avoiding the deleterious effects of serious anemia and the resulting oxygen debt, especially in vulnerable patients [2]. The administration of blood products is associated with well-described adverse consequences. There is always a small but distinct possibility for bacterial contamination as well as for errors in blood administration. The prolonged storage of blood products may decrease the ability of the red cell to transport or deliver oxygen through an abnormal microcirculation [4,5,6]. There is growing concern about limited supply and the escalating cost of blood transfusion
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