Bilgin Y M, Brand A
Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.
Vox Sang. 2008 Nov;95(4):261-71. doi: 10.1111/j.1423-0410.2008.01100.x.
Allogeneic blood transfusions are dose-dependently associated with postoperative complications. Leucocytes present in blood components may play a role in these effects, referred to as transfusion-related immunomodulation. Of 19 randomized controlled trials of the effect of allogeneic leucocytes in transfusions, 13 looked into the effect of leucocyte-containing red blood cells (RBCs) in the surgical setting on the occurrence of postoperative infections and/or mortality. In contrast to conflicting outcomes of the trials in other settings, in cardiac surgery there is evidence that leucocyte-containing RBCs increase postoperative complications associated with mortality. The studies performed in cardiac surgery show less heterogeneity than studies in other surgical interventions and had been conducted either in one or a few participating centres. In this review, we discuss possible explanations for these results in cardiac surgery (as opposed to other settings), which may relate to clinical as well as transfusional factors. We suggest that leucocyte-containing transfusions during and after cardiac surgery add a second insult to the cardiopulmonary bypass procedure-induced systemic inflammatory response.
异体输血与术后并发症呈剂量依赖性相关。血液成分中存在的白细胞可能在这些效应中发挥作用，这些效应被称为输血相关免疫调节。在19项关于异体白细胞在输血中作用的随机对照试验中，13项研究了含白细胞的红细胞（RBC）在手术环境中对术后感染和/或死亡率发生情况的影响。与其他环境下试验结果相互矛盾不同，在心脏手术中，有证据表明含白细胞的RBC会增加与死亡率相关的术后并发症。心脏手术中进行的研究显示出的异质性低于其他外科手术干预研究，并且这些研究是在一个或几个参与中心进行的。在本综述中，我们讨论了心脏手术（与其他环境相比）出现这些结果的可能解释，这可能与临床因素以及输血因素有关。我们认为，心脏手术期间及术后输注含白细胞的血液会给体外循环手术引发的全身炎症反应带来二次损伤。
