Vamvakas Eleftherios C, Blajchman Morris A
Department of Pathology and Laboratory Medicine, University of Ottawa, Faculty of Medicine, Canada.
Blood Rev. 2007 Nov;21(6):327-48. doi: 10.1016/j.blre.2007.07.003. Epub 2007 Sep 4.
Allogeneic blood transfusion (ABT)-related immunomodulation (TRIM) encompasses the laboratory immune aberrations that occur after ABT and their established or purported clinical effects. TRIM is a real biologic phenomenon resulting in at least one established beneficial clinical effect in humans, but the existence of deleterious clinical TRIM effects has not yet been confirmed. Initially, TRIM encompassed effects attributable to ABT by immunomodulatory mechanisms (e.g., cancer recurrence, postoperative infection, or virus activation). More recently, TRIM has also included effects attributable to ABT by pro-inflammatory mechanisms (e.g., multiple-organ failure or mortality). TRIM effects may be mediated by: (1) allogeneic mononuclear cells; (2) white-blood-cell (WBC)-derived soluble mediators; and/or (3) soluble HLA peptides circulating in allogeneic plasma. This review categorizes the available randomized controlled trials based on the inference(s) that they permit about possible mediator(s) of TRIM, and examines the strength of the evidence available for relying on WBC reduction or autologous transfusion to prevent TRIM effects.
同种异体输血（ABT）相关的免疫调节（TRIM）包括ABT后出现的实验室免疫异常及其已确定的或据称的临床效应。TRIM是一种真实的生物学现象，在人类中至少产生一种已确定的有益临床效应，但有害的临床TRIM效应的存在尚未得到证实。最初，TRIM包括通过免疫调节机制（如癌症复发、术后感染或病毒激活）归因于ABT的效应。最近，TRIM还包括通过促炎机制（如多器官功能衰竭或死亡）归因于ABT的效应。TRIM效应可能由以下因素介导：（1）同种异体单核细胞；（2）白细胞（WBC）衍生的可溶性介质；和/或（3）在同种异体血浆中循环的可溶性HLA肽。本综述根据它们对TRIM可能的介质所允许的推断，对现有的随机对照试验进行分类，并审查依靠白细胞减少或自体输血来预防TRIM效应的现有证据的强度。
