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Leukocyte Depletion and Transfusion-Induced Immunomodulation

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Book cover Clinical Benefits of Leukodepleted Blood Products

Part of the book series: Medical Intelligence Unit ((MIUN))

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Summary

The paradigm related to the immunologic consequences of allogeneic blood transfusions has been extended from humoral allosensitization to the effects of transfusion on cellular immune function. This includes down-regulation of effector cells, activation of latent viral infection, and the prolonged circulation of donor immunocompetent cells, as seen in graft-versus-host disease (GVHD).

In addition, there are now extensive data showing conclusively that allogeneic transfusions are associated with enhanced renal allograft tolerance, increased risks of cancer recurrence rates (about 80% in colorectal cancer) and postoperative bacterial infections (as much as 200–1000% in some studies). Whether these last two associations are causal or not remains in doubt although convincing animal data exist for all three outcomes. These associations are most likely in part due to immune modulation caused by transfusion, perhaps augmented by the effects of hemorrhage, anesthesia, and surgical stress.

The most likely mechanism underlying transfusion-induced immunosuppression is anergy due to presentation of large amounts of antigen through the intravenous route. This favors presentation of antigen by “non-professional” antigen presenting cells, a situation that usually leads to anergy or tolerance rather than immune activation. For some years it has been thought that transfused allogeneic white cells are the major mediator of transfusion induced immunomodulation. Results from animal and clinical studies strongly support this possibility. Results of some initial interventional studies, employing autologous transfusions or leukodepletion of allogeneic donor blood suggest that relatively simple, cost effective strategies to ameliorate these complications may be suitable for application in the near future.

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Authors
  1. Darrell J. Triulzi
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  2. Neil Blumberg
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© 1995 Springer-Verlag Berlin Heidelberg

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Triulzi, D.J., Blumberg, N. (1995). Leukocyte Depletion and Transfusion-Induced Immunomodulation. In: Clinical Benefits of Leukodepleted Blood Products. Medical Intelligence Unit. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-26538-3_9

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  • DOI: https://doi.org/10.1007/978-3-662-26538-3_9

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-1-57059-122-8

  • Online ISBN: 978-3-662-26538-3

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