risks of homologous blood transfusion, such a study is unethical. Less controversial would be randomization of patients likely to be transfused into an autologous blood program. A study utilizing multiple institutions in the Netherlands with over 500 colorectal cancer patients (23) found the relative risk of cancer recurrence for patients transfused with 1 -2 units of autologous blood was 1.78 compared to untransfused patients and 2.11 for recipients of 1 - 2 units of homologous blood. Both autologous and homologous transfusions were bufify coat poor, standard for the Netherlands. Blood transfusion, whether autologous or homologous, was associated with significantly increased risk of cancer recurrence but the risk for both groups was comparable. A randomized prospective study of colorectal cancer patients by Weiss et al., (34) from Munich randomized 120 patients to receive either homologous or autologous blood if transfusion were needed. With median follow-up of 21 months (9 - 48), the recurrence rate among homologous recipients is 29% compared to 17% among autologous recipients and was significant in both B (p = 0.032) and C (p = 0.006) tumors. Multivariate regression identified homologous blood as an independent prognostic factor (p = 0.008). EXPERIMENTAL STUDIES OF TRANSFUSION AND TUMOR GROWTH Experimental studies control for tumor burden (disease stage) and extent of the procedure including blood loss. Allogeneic blood transfusion produces profound changes in the immune systems of experimental animals which are analogous to those observed in man. Experimental studies have observed promotion or inhibition of tumor growth following allogeneic blood transfusions because the effect of transfusion on tumor growth is route-, tumor-, species-, and strain-specific. In mice, tail vein inoculation of basal call carcinoma produces pulmonary nodules which are inhibited by prior allogeneic transfusion while no effect is seen if the tumor is given subcutaneously (35). In the same strain, growth of subcutaneous adenocarcinoma is inhibited by transfusion while pulmonary nodules are unaffected. Timing of transfusion relative to tumor inoculation also determines subsequent tumor growth. Studies of tumor growth in experimental animals lack analogy to the situation in the cancer patient. The tumor has been present for years in patients with malignancies and some immunologic interaction between the host and the tumor has preceded the effects of surgery and blood transfusion. In experimental studies, tumor inoculation generally followed allogeneic transfusion. MISCELLANEOUS PHENOMENA ASSOCIATED WITH BLOOD TRANSFUSION Recurrent Abortion One of the most exciting, intriguing and controversial areas in which transfusion affects the outcome and has a therapeutic role is in the treatment of recurrent abortion. During pregnancy, lymphocyte function, as measured by responses to antigens, mitogens and homologous lymphocytes (MLR), is suppressed. Inhibition of lymphocyte function is due to serum factors, blocking antibodies which develop in response to trophoblast antigens. When spouses share HLA antigens, trophoblast antigens are not recognized by the pregnant woman's immune system, blocking antibodies are not produced, and the fetus is rejected. In 1981 Taylor and Faulk (36) induced suppressive sera in women suffering from recurrent spontaneous abortion and sharing HLA antigens with their spouse by transfusing the women with leukocyte-enriched plasma from

1995 ◽  
pp. 298-298
Keyword(s):  
Blood Transfusion ◽  
Tumor Growth ◽  
Autologous Blood ◽  
Experimental Studies ◽  
Hla Antigens ◽  
Cancer Recurrence ◽  
Pulmonary Nodules ◽  
Lymphocyte Function ◽  
Homologous Blood ◽  
Colorectal Cancer Patients

These studies indicate that homologous blood transfusion affects the outcome of clinical diseases in both beneficial and adverse ways. Experimental situations are not suitable for randomized clinical trials - transfusions cannot be given to prevent the onset of diabetes or wound strength measured in man following receipt of homologous or autologous blood. These experimental observations indicate that the outcomes of numerous clinical diseases which have not been studied may be manipulated by the use of homologous blood or that transfusion should be avoided. Several studies indicate that changes in immune function following transfusion are permanent. The number of clinical phenomena associated with immune suppression and attributable to blood transfusion is unknown. SUMMARY Given the evidence presented here it would be foolish to suggest that transfusion of homologous blood has no immunologic consequences for the recipient. Blood transfusion is the oldest form of transplant - no one would argue that transplantation between unrelated individuals has no influience on the immune system. In organ transplantation the immunologic sequelae are permanent and there is evidence that the same is true following homologous blood transfusion. Lymphocytopenia is present one year following surgery for Crohn's disease if patients receive perioperative blood transfusion (43). Colorectal cancer patients transfused more than seven years prior to diagnosis have significantly reduced numbers of lymphocytes and lower natural killer cytotoxicity than colorectal cancer patients who have never been transfused (44). Transfusion of neonates causes suppression of lymphocyte reactivity which is still demonstrable 25 to 30 years later (45). There is evidence that transfusion at any time prior to elective surgery increases susceptibility to infectious complications (14) and otherwise healthy transfused individuals may be at increased risk of developing malignancies (46). All the longterm consequences of blood transfusion are not negative: Survival of transplants is prolonged by pretransplant transfusion and some women suffering from recurrent spontaneous abortion can deliver at term if previously transfused with their spouse's leukocytes. In the future we will be able to transfuse blood without causing immune perterbations and the consequent clinical phenomena. Studies presented here suggest that removal of donor leukocytes reduces the risk of infection and cancer recurrence. The technology has not reached the point of reducing the leukocyte number in transfused blood below 10^/unit. An alternative which is increasingly being utilized is autologous blood programs. Physicians are discovering that patients tolerate hemoglobin levels which were previously unacceptably low and many patients prefer being anemic over the risks of receiving homologous blood. Since transfusion is an identifier of high cost hospitalized patients, alternatives to routine blood use are being studied in hopes of safely reducing the costs of transfusion. REFERENCES 1. Jubert AV, Lee ET, Hersh EM, McBride CM. J Surg Res 15:399-403, 1973. 2. M 19 u4n ( s3t ) e3r4A6-M 35 , 2 W , i1n9c8h1u . rch RA, Keane RM, Shatney CH, Ernst CB, Nuidema GD. Ann Surg

1995 ◽  
pp. 300-300
Keyword(s):  
Colorectal Cancer ◽  
Blood Transfusion ◽  
Cancer Patients ◽  
Randomized Clinical Trials ◽  
Elective Surgery ◽  
Autologous Blood ◽  
Homologous Blood ◽  
Homologous Blood Transfusion ◽  
One Year ◽  
Colorectal Cancer Patients

Since blood transfusion is linked to the magnitude of the surgical procedure, comparing transfused patients to untransfused patients will always be confounded by infection risks due to factors related to the procedure. To control for these factors one must compare patients transfused with red cells from different sources or prepared in a manner which minimize infection risk. Patients transfused with homologous blood have infection rates several fold higher than recipients of equal values of autologous blood undergoing the same operative procedure (20-23). Homologous blood recipients have significantly longer hospital stays attributed to treating infections. The cost of a blood transfusion exceeds the cost of collection, storage and administration because of transfusion's association with length of stay. In this era of cost-containment the association with prolonged stay may ultimately curtail the use of blood. Homologous blood can be filtered to remove donor leukocytes which may be contributing to immune suppression and infection risk. A prospective randomized trial comparing the infection rates among colorectal cancer patients receiving filtered and unfiltered blood has been conducted (9). There were 17 infectious complications among the 56 recipients of whole blood and one infectious complication among the 48 recipients of filtered blood. Infections were prevented by the seemingly simplistic addition of a $25/filter to every bag of blood transfused. These clinical studies are very convincing: homologous blood transfusion is associated with increased risk of infection in every clinical situation examined. In multivariate analyses transfusion was a significant predictor of infection after consideration of other variables measured and in the majority of those studies transfusion was the single most significant factor. Patients receiving homologous blood exhibited an incidence of infectious complications that was approximately four times higher than patients receiving autologous blood. The association of transfusion with infection is found among patients undergoing surgery for cardiac, orthopedic and gastrointestinal disorders and for trauma as well as among unoperated patients transfused for bums and gastrointestinal bleeding. The observation that nosocomial infections are increased in these studies argues strongly that the association of transfusion with infection is not simply a reflection of transfusion as a marker of tissue destruction and contamination. Infections that develop in transfused patients away from the site of trauma or in the absence of trauma, cannot be attributed to the quantity of tissue destroyed or to the degree of bacterial contamination. Filtered blood can remove leukocytes and prevent postoperative infections. Since filtering blood can significantly reduce the incidence of infection among transfused patients, all transfused blood will be passing through filters in the very near future. EXPERIMENTAL STUDIES RELATING BLOOD TRANSFUSION TO INCREASED RISK OF INFECTION Patients are extremely heterogeneous and even in prospective randomized trials, factors which influence patients' participation affect the outcome despite double-blinding and randomization. In animal studies using syngeneic strains with identical housing, lighting, access to food and water, control over the extent of injury, use of antibiotics and exposure to other variables the influence of a single variable such as blood transfusion can be measured. Dr. Waymack's laboratory has intensively studied parameters which interact with transfusion in

1995 ◽  
pp. 296-296
Keyword(s):  
Blood Transfusion ◽  
Autologous Blood ◽  
Experimental Studies ◽  
Infection Risk ◽  
Infectious Complications ◽  
Risk Of Infection ◽  
Infection Rates ◽  
Homologous Blood ◽  
Increased Risk ◽  
The Cost

Acute Isovolaemic Haemodilution: The Best Option for Autologous Blood Transfusion in Africa?

1995 ◽  
Vol 25 (4) ◽  
pp. 152-155 ◽  
Author(s):  
Zacharia A Berege ◽  
Bart Jacobs ◽  
Michael R Matasha ◽  
Frank Mpelumbe ◽  
Ernestini Kimaro
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Autologous Blood ◽  
Autologous Blood Transfusion ◽  
Total Blood Volume ◽  
East African ◽  
Homologous Blood ◽  
Total Blood ◽  
Induction Of Anaesthesia ◽  
Donated Blood

The purpose of this study was to identify the best method of autologous blood transfusion to be applied in an East African hospital. One hundred and nine consecutive patients for whom major blood loss was anticipated were enrolled. Seventeen patients donated 1 unit of blood 3 days preoperatively and 92 underwent acute isovolaemic haemodilution prior to induction of anaesthesia. For the haemodiluted patients a 2:1 ratio of sterile pryogen-free saline to collected blood was used. One of the 16 patients from whom 2 units were withdrawn by haemodilution experienced hypovolaemia which was rapidly restored by additional transfusion of colloid. Of the patients who donated blood preoperatively only 23.5% were autotransfused compared to 98.9% of the haemodiluted patients. Of the latter 23.9% (22) had an intraoperative blood loss exceeding 15% of their total blood volume and 7.6% (7) lost more than 25%. Only one received homologous blood in addition. For hospitals with limited blood bank facilities and regular cancellation of surgery, the use of acute isovolaemic haemodilution is recommended. A 3:1 ratio of saline to blood is now advised when 1 unit is withdrawn and a part replacement with crystalloid when 2 units are collected.

scholarly journals Intraoperative red blood cell salvage and autologous transfusion during open radical retropubic prostatectomy: a cost–benefit analysis

2011 ◽  
Vol 93 (2) ◽  
pp. 157-161 ◽  
Author(s):  
Sarvpreet Ubee ◽  
Manal Kumar ◽  
Nallaswami Athmanathan ◽  
Gurpreet Singh ◽  
Sean Vesey
Keyword(s):  
Blood Transfusion ◽  
Autologous Blood ◽  
Radical Retropubic Prostatectomy ◽  
Autologous Blood Transfusion ◽  
Cell Saver ◽  
Cell Salvage ◽  
Homologous Blood ◽  
Retropubic Prostatectomy ◽  
Group A ◽  
Group B

INTRODUCTION Open radical retropubic prostatectomy (RRP) has an average blood loss of over 1,000ml. This has been reported even from high volume centres of excellence. 1 – 4 We have looked at the clinical and financial benefits of using intraoperative cell salvage (ICS) as a method of reducing the autologous blood transfusion requirements for our RRP patients. MATERIALS AND METHODS Group A comprised 25 consecutive patients who underwent RRP immediately prior to the acquisition of a cell saver machine. Group B consisted of the next 25 consecutive patients undergoing surgery using the Dideco Electa (Sorin Group, Italy) cell saver machine. Blood transfusion costs for both groups were calculated and compared. RESULTS The mean postoperative haemoglobin was similar in both groups (11.1gm/dl in Group A and 11.4gm/dl in Group B). All Group B patients received autologous blood (average 506ml, range: 103–1,023ml). In addition, 5 patients (20%) in Group B received a group total of 16 units (average 0.6 units) of homologous blood. For Group A the total cost of transfusing the 69 units of homologous blood was estimated as £9,315, based on a per blood unit cost of £135. This cost did not include consumables or nursing costs. CONCLUSIONS We found no evidence that autologous transfusions increased the risk of early biochemical relapse or of disease dissemination. ICS reduced our dependence on donated homologous blood.

scholarly journals Should Autologous Blood Transfusion be Rediscovered?

1980 ◽  
Vol 8 (2) ◽  
pp. 168-171 ◽  
Author(s):  
James P. Isbister ◽  
Richard Davis
Keyword(s):  
Blood Transfusion ◽  
Autologous Blood ◽  
Autologous Blood Transfusion ◽  
Homologous Blood ◽  
Homologous Blood Transfusion ◽  
Efficient Alternative

With a greater appreciation and understanding of reactions to homologous blood transfusion there has been a renewed interest in autologous blood transfusion. The techniques and indications for preoperative banked autologous blood, perioperative haemodilution and recycled salvaged autologous blood transfusion are described. When circumstances permit, autologous blood transfusion is a safe, economical and efficient alternative to homologous blood.

The Mechanism of Transfusion-Related Immunomodulation Is Related to the Transfusion of Dendritic Cells Expressing the CD200 (OX-2) Tolerance Signal and Alloantigen: Evidence from a Murine Tumor Model.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 831-831
Author(s):  
Morris A. Blajchman ◽  
Reginald M. Gorczynski ◽  
David A. Clark
Keyword(s):  
Dendritic Cells ◽  
Blood Transfusion ◽  
Tumor Growth ◽  
Pulmonary Nodules ◽  
Suppressor Cells ◽  
Tumor Model ◽  
Allogeneic Blood ◽  
Promoting Effect ◽  
Growth Promoting ◽  
Resistance To Infection

Abstract Background: The transfusion of blood products containing allogeneic leukocytes can alter recipient resistance to infection and stimulate the growth of some types of tumors in animal models of transfusion-induced tumor growth. Transfusion related immunomodulation (TRIM) represents a credible mechanism for the altered resistance to infection seen clinically, but cannot explain the growth of non-immunogenic tumors in syngeneic hosts seen regularly in the various transfusion-related animal models of tumor growth. Methods and Results: In this study the transfusion of 50–200 μL of unmodified anticoagulated allogeneic BALB/c (H-2d) mouse blood into C57B1/6 (H-2b) mice, four days before being intravenously injected with syngeneic (H-2b) FSL10 fibrosarcoma cells (1–2 x 106 cells per mouse) resulted in a significant increase in the number of pulmonary nodules observed at 3 weeks compared to that seen in control mice. The median number of pulmonary nodules increased in an allogeneic blood transfusion dose-dependent manner, as did the proportion of mice without pulmonary nodules. This tumor growth-promoting effect of the allogeneic blood transfusions required the presence in the transfused blood of allogeneic CD11c+ dendritic cells bearing the CD200 co-stimulatory tolerance signal. This tumor growth-promoting effect of allogeneic blood could be blocked by specific monoclonal antibodies to either CD11c or to CD200. CD200 receptor-mediated signaling alone, in the absence of alloantigen, failed to augment the number of TRIM-induced pulmonary tumor nodules. Physiological concentrations of TGFβ, but not IL-10, were shown to stimulate proliferation of FSL10 cells in vitro in these studies. In this context, it is known that CD200 together with alloantigens are known to stimulate development of suppressor cells acting via IL-10 and TGFβ in vivo. Allogeneic blood also caused a significant CD200-dependent accumulation of TGFβ+ suppressor cells in the spleen, 12 days after transfusion, when the spleen cells could be shown to adoptively transfer the TRIM effect to naive animals. Conclusions: These data support the hypothesis that allogeneic transfusions in an allogeneic blood transfusion mouse tumor model results in tumor growth promotion in recipient mice. This effect appears to result in both the induction of TGFβ-producing suppressor cells as well as requiring the transfusion of allogeneic CD11c+ dendritic cells, bearing both CD200 tolerance signaling molecules and alloantigens.

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