scholarly journals Impact of transfusion of blood components on the recipient immune system

2021 ◽  
Vol 23 (6) ◽  
pp. 1307-1318
Author(s):  
T. V. Glazanova ◽  
E. R. Shilova ◽  
A. V. Chechetkin ◽  
L. N. Bubnova
Keyword(s):  
Immune System ◽  
Immune Modulation ◽  
Hla Antigens ◽  
Perioperative Period ◽  
Blood Component ◽  
Malignant Neoplasms ◽  
Blood Components ◽  
Transfusion Therapy ◽  
Storage Lesion

Transfusions of blood provide essential therapeutic measures in a number of pathological conditions. However, when carrying out blood component therapy, it is important to consider probability of post-transfusion complications. Most of them are immune-mediated side effects. The unfavorable consequences of blood transfusions can manifest at long-range time periods, and pathogenesis of these phenomena may be associated not only with the presence of alloantibodies. They may be caused by alloimmunization to HLA antigens, leukocyte factors, including cytokines, products of leukocyte degranulation, as well as storage-related erythrocyte damage («storage lesion»), immunomodulatory properties of extracellular vesicles or microparticles derived from blood components, and other factors. Despite significant number of publications on this issue, a lot of unresolved issues still remain, concerning transfusion-related effects of blood components on the immune system of recipients. The review article provides the results of current studies in this area. We present and discuss the results of current studies and the features of transfusion-mediated immunomodulation (TRIM) revealed over recent years, when transfusing different blood components. The role of plasma factors, microparticles, platelets and erythrocytes, HLA sensitization and microchimerism in the development of TRIM is highlighted, the data on occurrence and clinical features of TRIM in perioperative period are presented. A separate section of the review provides information about recent clinical studies, devoted to the issues of TRIM in different clinical cohorts, including newborns, patients with malignant neoplasms, immunocompromised patients after heart and vascular surgery. The data on TRIM incidence in the patients with exhausted immune system due to previous disease or treatment, severe comorbidity, extensive surgical thoracic/abdominal intervention and artificial circulation are also in scope. As based on the studies performed, the role of distinct measures, e.g., washing of erythrocyte concentrates, leukodepletion, and gamma irradiation are discussed in view of potential TRIM prevention. The results of published research do not allow us to draw definite conclusions about the effects of blood component transfusion on the immune system of recipients with respect to differences between the studied groups of patients, characteristics of the studied disorders and clinical situations, diversity of hemocomponents, as well as varying standards of transfusion therapy adopted in different countries. However, the systematic literature review may provide some guidance in transfusion-mediated immune modulation.

Product Attributes and Donor Factors in Reported Cases of Transfusion-Associated Graft Versus Host Disease: A Systematic Review

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2883-2883
Author(s):  
Ilana Kopolovic ◽  
Jackie Ostro ◽  
Christine Cserti ◽  
Walter Sunny Dzik ◽  
Hidacki Tsubota ◽  
...  
Keyword(s):  
Storage Time ◽  
Hla Antigens ◽  
Hla Class I ◽  
Class Ii ◽  
Hla Typing ◽  
Class I ◽  
Blood Component ◽  
Blood Components ◽  
Donor Factors ◽  
Related Donor

Abstract INTRODUCTION: Transfusion-associated graft-vs-host disease (TA-GVHD) is a rare and often fatal complication of transfusion of cellular blood products. The relative contributions of product and donor factors to the risk of TA-GVHD remain uncertain. METHODS: Systematic review of all reported cases of TA-GVHD in the published literature prior to Oct 2013, without language restrictions. Cases attributed to granulocyte transfusions, passenger lymphocyte syndrome, or GVHD following stem-cell transplant (unless traced to blood components rather than the graft) were excluded. Data collected included patient demographics and health information, details of transfusion event(s) and blood component(s), clinicolaboratory features of the TA-GVHD presentation and outcome, and results of human leukocyte antigen (HLA) and chimerism studies. HLA typing was evaluated where reported for both donor (product) and recipient at either class I or class II loci. Donor/recipient pairs were categorized as D=0 when there were no identified donor HLA antigens foreign to the recipient, or D>0 when donor cells contained one or more HLA antigens not found in the recipient. This classification applied separately to HLA class I and class II loci for each case. RESULTS: After removing duplicates, 2130 citations discovered by the search were examined by two independent reviewers, with 394 identified as publications of interest for complete review. An additional 21 publications were found from the initial review, for a total of 415 publications. Of these, 195 publications described 348 unique cases for inclusion. Component: The component implicated in TA-GVHD was identified in 248 (71%) cases: Red cells (RBC) in 132 (38%); whole blood (WB) in 92 (26%); platelets in 20 (6%); buffy- coat product in 2 (0.6%); and plasma and plasma-reduced blood in one case each. In 100 (29%) cases, the blood component was either not specified or not identified among several potentially responsible components. Storage: Component storage time was reported in 158 (45%) cases. Of these, the implicated product was either described as “fresh” or </=10 days old in 148 (94%). 10 (6%) cases reported a storage time >10 days (maximum 14 days). Related donor: In 63 cases, the donor was either related (n=61) or deliberately HLA-matched (n=2) to the recipient, while in 113 cases the donor was unrelated. The remaining cases either reported a “possible” related donor or did not report the donor-recipient relationship. Leukoreduction/Irradiation: Leukoreduction status was reported in 135 (39%) cases. Of these, the implicated product was leukoreduced in 23 (17%) (10 bedside, 2 pre-storage, 11 not specified). The product was irradiated in 9 cases. HLA: HLA typing of recipient and donor, by serological or molecular techniques, was available for 84 cases (74 cases Class I, 62 Class II). Among patients with HLA data available, 20 (24%) had an underlying diagnosis warranting irradiation by current standards, while 64 (76%) did not. The category of D=0 was found in 47 (64%) of cases with reported class I typing; 44 (71%) of cases with reported class II typing; and 60 (71%) overall (Figure 1). There were 9 cases in which the category of D=0 could be ruled out for both HLA I and II. In the remaining 15 cases, the category of D=0 at either HLA I or II could not be definitively ruled in or out based on reported data. When considering those in whom the presence or absence of D=0 could be definitely determined, while D=0 at either HLA class I or class II was present in 55 of 57 (96%) of recipients without an indication for blood component irradiation, D=0 was present in only 5 of 12 (42%) of recipients with an indication for irradiation, p< 0.0001 (Table 1). CONCLUSIONS: The most common components implicated in TA-GVHD were WB and RBC. Most units were non-leukoreduced and stored for <10 days. Most cases of TA-GVHD occurred in recipients without a standard indication for irradiation. The absence of a foreign donor antigen at either HLA class I or class II occurred in a large majority of cases and was significantly more common in TA-GVHD among recipients without an indication for irradiation compared with those in whom irradiation would be indicated, suggesting that this donor-recipient relationship is the predominant risk factor in the development of TA-GVHD. Policies for irradiating cellular blood components based solely on the diagnosis of the recipient may fail to address all relevant risk factors for TA-GVHD. Figure 1 Figure 1. Table 1. Table 1. Disclosures No relevant conflicts of interest to declare.

Highly glycosylated tumour antigens: interactions with the immune system

2011 ◽  
Vol 39 (1) ◽  
pp. 388-392 ◽  
Author(s):  
Eirikur Saeland ◽  
Yvette van Kooyk
Keyword(s):  
Immune System ◽  
Immune Modulation ◽  
Diagnostic Tools ◽  
Phenotypic Change ◽  
Carbohydrate Binding ◽  
Lectin Receptors ◽  
Functional Studies ◽  
Tumour Antigens ◽  
Antigen Presenting

A common phenotypic change in cancer is a dramatic transformation of cellular glycosylation. Functional studies of particular tumour-associated oligosaccharides are difficult to interpret conclusively, but carbohydrate-binding proteins are likely to contribute to progression of the tumour. This review discusses the potential role of CLRs (C-type lectin receptors), expressed by antigen-presenting cells of the immune system, in tumour recognition and immune modulation. Studies in recent years have provided significant insight into the immunomodulatory function of CLR during infections, but their role in cancer remains elusive; some strongly bind tumour cells and antigens, indicating participation in malignancy. The potential to use recombinant CLR as diagnostic tools will also be discussed.

scholarly journals The Role of Progesterone in Feto-Maternal Immunological Cross Talk

2018 ◽  
Vol 27 (4) ◽  
pp. 301-307 ◽  
Author(s):  
Julia Szekeres-Bartho
Keyword(s):  
T Cells ◽  
Immune System ◽  
Nk Cells ◽  
Hla Antigens ◽  
Γδ T Cells ◽  
Normal Pregnancy ◽  
Maternal Immune System ◽  
Immunological Recognition ◽  
Immunological Relationship

This review aims to provide a brief historical overview of the feto-maternal immunological relationship, which profoundly influences the outcome of pregnancy. The initial question posed in the 1950s by Medawar [Symp Soc Exp Biol. 1953; 7: 320–338] was based on the assumption that the maternal immune system recognizes the fetus as an allograft. Indeed, based on the association between HLA-matching and spontaneous miscarriage, it became obvious that immunological recognition of pregnancy is required for a successful gestation. The restricted expression of polymorphic HLA antigens on the trophoblast, together with the presence of nonpolymorphic MHC products, excludes recognition by both T and NK cells of trophoblast-presented antigens; however, γδ T cells, which constitute the majority of decidual T cells, are likely candidates. Indeed, a high number of activated, progesterone receptor-expressing γδ T cells are present in the peripheral blood of healthy pregnant women and, in the presence of progesterone, these cells secrete an immunomodulatory protein called progesterone-induced blocking factor (PIBF). As early as in the peri-implantation period, the embryo communicates with the maternal immune system via PIBF containing extracellular vesicles. PIBF contributes to the dominance of Th2-type reactivity which characterizes normal pregnancy by inducing increased production of Th2 cytokines. The high expression of this molecule in the decidua might be one of the reasons for the low cytotoxic activity of decidual NK cells.

scholarly journals Some cases of transfusion-related acute lung injury in clinical practice

2015 ◽  
Vol 22 (3) ◽  
pp. 29-34
Author(s):  
B. B. Bakhovadinov ◽  
G. S. Ashurova ◽  
M. A. Kucher ◽  
A. Y. Tretyakova ◽  
A. B. Khodzhiev ◽  
...  
Keyword(s):  
Critical Care ◽  
Acute Lung Injury ◽  
Clinical Practice ◽  
Lung Injury ◽  
Clinical Symptoms ◽  
Blood Components ◽  
Transfusion Therapy ◽  
Prevention Protocol ◽  
Diagnosis Criteria

Preparation of this publication was motivated by a desire to present contemporary authors look at one of the most important branches of critical care medicine - transfusion therapy and related complications, such as transfusion-related lung injury (TRALI). The article describes the causes, pathogenesis, diagnosis and therapy of TRALI patients in critical condition. In this article attention is paid to the diagnosis of TRALI, associated with transfusion of blood components, modern diagnosis criteria. The authors describe the clinical symptoms, treatment schema and propose prevention protocol of TRALI. In order to determine the incidence of TRALI in medical practice transfusion therapy data in 1900 patients was analyzed. The development of this complication was found in 12 patients, 5 patients had «possible TRALI», which is comparable with the literature data. In 5 patients and 11 donors at a laboratory study anti-leukocyte antibodies were found. The important role of prevention, based on the immune mechanisms of the pathogenesis of TRALI is marked.

Consequences of Transfusing Blood Components in Patients With Trauma: A Conceptual Model

2017 ◽  
Vol 37 (2) ◽  
pp. 18-30 ◽  
Author(s):  
Allison R. Jones ◽  
Susan K. Frazier
Keyword(s):  
Conceptual Model ◽  
Traumatic Injury ◽  
Blood Component ◽  
Blood Components ◽  
Storage Lesion ◽  
Trauma Outcomes ◽  
Packed Red Blood Cells ◽  
Blood Component Transfusion ◽  
Patient’S Outcome

Transfusion of blood components is often required in resuscitation of patients with major trauma. Packed red blood cells and platelets break down and undergo chemical changes during storage (known as the storage lesion) that lead to an inflammatory response once the blood components are transfused to patients. Although some evidence supports a detrimental association between transfusion and a patient’s outcome, the mechanisms connecting transfusion of stored components to outcomes remain unclear. The purpose of this review is to provide critical care nurses with a conceptual model to facilitate understanding of the relationship between the storage lesion and patients’ outcomes after trauma; outcomes related to trauma, hemorrhage, and blood component transfusion are grouped according to those occurring in the short-term (≤30 days) and the long-term (&gt;30 days). Complete understanding of these clinical implications is critical for practitioners in evaluating and treating patients given transfusions after traumatic injury.

scholarly journals The Role and Clinical Interest of Extracellular Vesicles in Pregnancy and Ovarian Cancer

Biomedicines ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1257
Author(s):  
Nazanin Yeganeh Kazemi ◽  
Benoìt Gendrot ◽  
Ekaterine Berishvili ◽  
Svetomir N. Markovic ◽  
Marie Cohen
Keyword(s):  
Ovarian Cancer ◽  
Immune System ◽  
Extracellular Vesicles ◽  
Vascular Remodeling ◽  
Immune Modulation ◽  
Cancer Metastasis ◽  
Cell Communication ◽  
Host Immune System ◽  
In Pregnancy

Ovarian cancer and pregnancy are two states in which the host immune system is exposed to novel antigens. Indeed, both the tumor and placenta must invade tissues, remodel vasculature to establish a robust blood supply, and evade detection by the immune system. Interestingly, tumor and placenta tissue use similar mechanisms to induce these necessary changes. One mediator is emerging as a key player in invasion, vascular remodeling, and immune evasion: extracellular vesicles (EVs). Many studies have identified EVs as a key mediator of cell-to-cell communication. Specifically, the cargo carried by EVs, which includes proteins, nucleic acids, and lipids, can interact with cells to induce changes in the target cell ranging from gene expression to migration and metabolism. EVs can promote cell division and tissue invasion, immunosuppression, and angiogenesis which are essential for both cancer and pregnancy. In this review, we examine the role of EVs in ovarian cancer metastasis, chemoresistance, and immune modulation. We then focus on the role of EVs in pregnancy with special attention on the vascular remodeling and regulation of the maternal immune system. Lastly, we discuss the clinical utility of EVs as markers and therapeutics for ovarian cancer and pre-eclampsia.

scholarly journals Predictive role of baroreflex sensitivity in the assessment of perioperative risk. Article

2020 ◽  
pp. 49-62
Author(s):  
I. B Zabolotskikh ◽  
N. V Trembach
Keyword(s):  
Baroreflex Sensitivity ◽  
Perioperative Complications ◽  
Perioperative Period ◽  
Perioperative Risk ◽  
General Anesthetics ◽  
Transfusion Therapy ◽  
Sensitivity Assessment ◽  
Pubmed Database ◽  
Increase In Risk

Violation of baroreflex sensitivity often accompanies the progression of chronic diseases. Given the fact that baroreflex dysfunction has long been known as a longterm prognostic marker of adverse cardiovascular disease outcomes, interest in the role of baroreflex sensitivity assessment in determining perioperative risk has increased significantly over the past decades. An analysis of the literature showed that for the query baroreflex + anesthesia, an automatic search in the PubMed database allows you to select 592 research papers, of which only 28 are randomized controlled trials. A significant amount of experimental and clinical data has been accumulated, indicating an important role of baroreflex during the perioperative period. The conducted research allows us to state with confidence the fact that the sensitivity of the baroreflex, equal to 3 ms/mm Hg regardless of the method of its assessment, it is a critical value below which the baroreflex function is associated with an increase in the probability of an adverse outcome, including the development of perioperative complications. The pathophysiological mechanisms underlying the increase in risk with a decrease in baroreflex sensitivity include an increase in the frequency of hemodynamic critical incidents, a greater susceptibility to the negative effects of mechanical ventilation, an increase in the need for infusion-transfusion therapy, a more pronounced pain syndrome and a violation of the immune system. The negative effect of general anesthetics and neuroaxial anesthesia on baroreflex leads to a further increase in risk. Given the role of baroreflex in the pathogenesis of perioperative disorders, the assessment of baroreflex can be a key point of an individual approach to the management of the perioperative period.

Role of probiotics in prevention and treatment of diarrhea and disbiosis in infants

2021 ◽  
Author(s):  
С.Г. Грибакин
Keyword(s):  
Immune System ◽  
Immune Modulation ◽  
Genome Structure ◽  
Treatment And Prevention ◽  
Healthy Infants ◽  
Dopamine And Serotonin Receptors ◽  
Complex Ecosystem ◽  
Inflammatory Bowel ◽  
Irritable Bowel

Кишечная микробиота представляет собой сложную экосистему, образованную сообществом микроорганизмов, которое расценивается как самостоятельный метаболический орган. Преобладающими микроорганизмами в толстой кишке здорового младенца являются бифидобактерии и лактобациллы, которые конкурентно подавляют рост условно-патогенных и патогенных микробов и способствуют развитию иммунной системы. На протяжении последних 10 лет исследования в области молекулярной биологии и строения генома Bifidobacterium и Lactobacillus были сфокусированы на таких проблемах, как взаимодействие с иммунной системой и перспективы их использования при антибиотик-ассоциированной диарее и при диареях в педиатрической практике, а также при синдроме раздраженного кишечника и при воспалительных заболеваниях кишечника. За последние годы выполнен целый ряд клинических исследований, посвященных использованию пробиотиков в целях лечения и профилактики диареи у детей, а также подготовлено несколько подробных метаанализов, которые дают достаточно полное представление о возможностях использования монокомпонентных и комбинированных пробиотических препаратов. Получены важные факты в пользу того, что определенные штаммы Lactobacilli и Bifidobacteria являются иммуномодуляторами и способны влиять на иммунную регуляцию посредством воздействия на баланс между провоспалительными и противовоспалительными цитокинами. Еще одним механизмом действия пробиотических препаратов является их влияние на допаминовые и серотониновые рецепторы, благодаря чему установлено положительное влияние пробиотиков у пациентов, находящихся в состоянии стресса и при депрессивных состояниях. В статье показано, что комбинированные пробиотики обладают синергическим действием, оказывают антибактериальное действие и иммуномодулирующий эффект и обладают доказанной клинической эффективностью при диарее и дисбактериозе у детей. Intestinal microbiota is a complex ecosystem of the community of enteric microorganisms and is estimated as an individual metabolic organ. Bifidobacteria and Lactobacilli are the predominant microbes in a colon of healthy infants, they are able to suppress a growth of pathogenic and conditionally pathogenic microorganisms and support a development of immune system. Over the past 10 years, research in the field of molecular biology and genome structure of Bifidobacterium and Lactobacillus has focused on such problems as interaction with the immune system and the prospects for their use in antibiotic-associated diarrhea and diarrhea in pediatric practice, as well as in irritable bowel syndrome and inflammatory bowel disease. In recent years, a number of clinical studies have been carried out on the use of probiotics for the treatment and prevention of diarrhea in children, and several detailed analytical meta-analyzes have been prepared, which give a fairly complete picture of the possibilities of using monocomponent and combined probiotic drugs. Important facts have been obtained in favor of the fact that certain strains of Lactobacilli and Bifidobacteria are immunomodulators and are able to influence immune regulation by affecting the balance between pro-inflammatory and anti-inflammatory cytokines. Another mechanism of action of probiotic drugs is their effect on dopamine and serotonin receptors, due to which a positive effect of probiotics has been established in patients under stress and in depression. The article shows that combined probiotic remedies are characterized by synergic action and have an antibacterial effect and immune modulation. Combined probiotics are characterized by synergic activity and support a development of immune system. Due to these properties they have a clinically proven effect in diarrhea and disbiosis in infants.

scholarly journals Rational Clinical Use of Blood and Blood products – A summary

2017 ◽  
Vol 7 (1) ◽  
pp. 1111-1117 ◽  
Author(s):  
D Ghartimagar
Keyword(s):  
Blood Component ◽  
Physiological Status ◽  
Blood Collection ◽  
Main Role ◽  
Blood Components ◽  
Blood Products ◽  
Right Reason ◽  
Compatible Blood ◽  
The Right

Blood transfusion is an essential therapeutic intervention. The main role of the blood centre is to provide safe and timely blood and blood component(s) to the patients that will improve the physiological status of the patient. Various blood components can be harvested from a single donation of whole blood. The blood centre ensures that there is an adequate inventory of all blood types and blood components to meet the needs of the patients. The blood centre does donor selection, blood collection, component preparation, screening for transfusion – transmitted infections and blood processing. Serologically compatible blood and components are provided to the patients after meticulous pre-transfusion testing as per the standard protocol. Rational use of blood and blood products means right product is used with the right dose on right time for the right reason.

scholarly journals Testing of platelet function and application of rotary thromboelastometry in order to rationalize chemotherapy during myocardial revascularization and surgical treatment of heart valves

2020 ◽  
Vol 1 (3) ◽  
pp. 119-126
Author(s):  
Danijela Vuković ◽  
Tanja Živković ◽  
Milena Todorović ◽  
Branko Čalija ◽  
Petar Vuković ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Platelet Function ◽  
Disease Transmission ◽  
Point Of Care ◽  
Myocardial Revascularization ◽  
Perioperative Period ◽  
Allogeneic Blood ◽  
Blood Component ◽  
Transfusion Therapy ◽  
Perioperative Morbidity

Using intraoperative salvage of blood/erythrocytes (ISB/E) in the practice, rationalized application of allogeneic blood products and hemostatic-active drugs - based on "point-of-care" (POC) monitoring findings - it is possible to improve diagnosis and evaluate of transfusion hazards and increase efficacy of therapy of patients with excessive bleedings, with reduction of perioperative morbidity and mortality in cardiac surgery. This study was performed as a prospective analysis of platelet function using "multiple platelet function analyzer" (MEA; by Multiplate) system and examination of hemostasis by rotational thromboelastometry (ROTEM) during and immediately following myocardial revascularization and surgical treatment of valves in the Institute of Cardiovascular Diseases "Dedinje" for six years period for therapy of 1021 random selected patients. The study aim was to evaluate the influence of ISB/E and hemostatic drugs - indicated based on the results of platelet count and function (Multiplate) and hemostasis monitoring (ROTEM) in compared to allogeneic transfusions - on the incidence of bleedings, treatment efficiency and overall clinical outcome. In the perioperative period, a total of 617 (60.4%) patients were treated with ISB/E reinfusion only. Other patients (404; 39.6%) received allogeneic blood components too. Total 391 of them (38.3%) were treated (together by ISB/E) with transfusion of one to three units of allogeneic red blood cells (RBCs). There were only 13 (1.3%) polytransfunded (typically 10 - 15 units) patients. The rate of cardio-surgical reinterventions due to bleeding was only 2.5%. In conclusion, the application of the ISB/E strategy represents an effective and safe (reduced immune-mediated complications and risk of disease transmission) therapeutic approach. By monitoring MEA/ROTEM and implementation the algorithm of current transfusion therapy, it is possible to reduce significantly of allogeneic blood component therapy. The use of allogeneic RBCs is justified only when the possibilities of autologous transfusion and pharmacological hemostatic therapy have been exhausted.

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