Blumberg N, Heal J M
Department of Pathology, University of Rochester Medical Center, NY 14642.
Arch Pathol Lab Med. 1989 Mar;113(3):246-53.
For some time it has been known that allogeneic blood transfusions have immunologic effects on animal and human recipients. These effects include increased numbers of suppressor T cells, decreased natural killer-cell function, decreased function of macrophages and monocytes, induction of anti-idiotypic antibodies that suppress allogeneic antigen recognition, and decreases in alloreactivity of mononuclear cells in mixed lymphocyte cultures. The meaning of these changes is not clearly understood, nor is the exact clinical importance of these alterations known. However, these decreases in immunologic function may explain a number of clinical consequences some investigators believe are the sequelae of homologous blood transfusions. Clinically important outcomes that are associated with transfusions are improved survival of renal allografts and increased risks of bacterial infection and cancer recurrence after perioperative transfusions. Transfusion of plasma-rich blood components (eg, whole blood) has been specifically associated with earlier cancer recurrence and better renal allograft survival in some patient groups. The new hypothesis that transfusion of stored plasma is a major factor in altering host immune defenses is supported by the observation that patients infected with human immunodeficiency acquired immunodeficiency syndrome more rapidly if they have been transfused with large amounts of plasma. Contrary to previous belief, the transfusion of homologous stored blood plasma may have as great or greater effects on immunity than transfusion of white blood cells. We believe investigation into the immunologic effects of transfusions is likely to have a significant impact on transfusion medicine research and practice over the coming years.
一段时间以来，人们已经知道异体输血对动物和人类受血者具有免疫作用。这些作用包括抑制性T细胞数量增加、自然杀伤细胞功能降低、巨噬细胞和单核细胞功能降低、诱导抑制异体抗原识别的抗独特型抗体，以及混合淋巴细胞培养中单核细胞的同种异体反应性降低。这些变化的意义尚未完全清楚，这些改变的确切临床重要性也不清楚。然而，这些免疫功能的降低可能解释了一些研究者认为是同源输血后遗症的许多临床后果。与输血相关的重要临床结果包括肾移植存活率提高以及围手术期输血后细菌感染和癌症复发风险增加。在一些患者群体中，输注富含血浆的血液成分（如全血）与癌症早期复发和肾移植存活率提高有特定关联。输注储存血浆是改变宿主免疫防御的主要因素这一新假说得到了以下观察结果的支持：感染人类免疫缺陷病毒获得性免疫缺陷综合征的患者如果输注大量血浆，病情进展会更快。与先前的看法相反，输注同源储存血浆对免疫的影响可能与输注白细胞一样大或更大。我们认为，对输血免疫作用的研究可能在未来几年对输血医学研究和实践产生重大影响。
