Goubran Hadi, Seghatchian Jerard, Radosevic Julia, Ragab Gaafar, Burnouf Thierry
Saskatoon Cancer Centre and College of Medicine, University of Saskatchewan, Saskatchewan, Canada.
International Consultancy in Blood Components Quality/Safety Improvement, Audit/Inspection and DDR Strategies, London, UK.
Transfus Apher Sci. 2017 Jun;56(3):330-335. doi: 10.1016/j.transci.2017.05.023. Epub 2017 Jun 3.
Our microbiota is determined by many variables including ABO blood groups. The microbiota is not only confined to the gut and skin but is also recoverable from blood of healthy donors. The microbiota shape our immune system through cross reactivity with antigens, the expression of direct molecular patterns, the release of cytokines, the effects on nutrients and micronutrients and even through an interplay with epigenetics. It is likely, therefore, that a donor's microbiota could alter the antigenicity of blood and its components and potentially contribute to transfusion-related immune modulation [TRIM]. It could also potentially transmit infections. The recipient's microbiome contributes, on the other hand, to the tolerance to transfused blood, or to the development of transfusion reactions. Cancer patients are a particularly vulnerable population, often immunosuppressed with a significantly altered microbiota. They are more at risk for transmission of "dormant" bacteria via blood transfusion. Furthermore, chemotherapy and radiation induce mucositis that likely results in significant translocation of gut microbiota and abnormal immune reactions to transfused blood. It is therefore relevant to revisit transfusion thresholds and consider transfusion-saving strategies in cancer patients.
我们的微生物群由包括ABO血型在内的许多变量决定。微生物群不仅局限于肠道和皮肤，也可从健康供体的血液中检测到。微生物群通过与抗原的交叉反应、直接分子模式的表达、细胞因子的释放、对营养素和微量营养素的影响，甚至通过与表观遗传学的相互作用来塑造我们的免疫系统。因此，供体的微生物群可能会改变血液及其成分的抗原性，并可能导致输血相关的免疫调节（TRIM）。它还可能传播感染。另一方面，受者的微生物群有助于对输血的耐受性，或导致输血反应的发生。癌症患者是一个特别脆弱的群体，他们通常免疫功能低下，微生物群显著改变。他们通过输血感染“潜伏”细菌的风险更高。此外，化疗和放疗会诱发粘膜炎，这可能导致肠道微生物群的大量移位以及对输血的异常免疫反应。因此，重新审视输血阈值并考虑癌症患者的输血节省策略是有必要的。
