Wendelbo Øystein, Opheim Elin Netland, Hervig Tor, Felli Lunde Turid Helen, Bruserud Øystein, Mollnes Tom Eirik, Reikvam Håkon
Department of Medicine, Haukeland University Hospital, Bergen, Norway.
Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway.
Vox Sang. 2018 Oct;113(7):657-668. doi: 10.1111/vox.12703. Epub 2018 Aug 29.
In a previous pilot study, we demonstrated significantly lower haemoglobin (Hb) increment after red-blood-cell (RBC) transfusions in febrile patients compared to patients without fever. The aim of this study was to examine associations between inflammatory mediators and post-transfusion haemoglobin increment in patients with haematological diseases.
Twenty-seven patients (eight women, 19 men), median age 56 years receiving RBC transfusion, were included in the study. Hb increment per unit transfused was corrected for estimated patient blood volume and the amount of Hb transfused. A wide spectrum of inflammatory mediators was determined by multiplex technology. Association between post-transfusion haemoglobin increment, plasma inflammatory mediators and patient characteristics was analysed using a mixed linear regression model.
Febrile patients had significantly lower corrected Hb increment, significantly increased values of IL-6, IL-8, IL-10 and G-CSF, significantly reduced levels of CCL5 and CXCL10, and significantly higher pretransfusion levels of CRP. There was a significant association between pretransfusion CRP levels and corrected Hb increment for the whole patient cohort, but not within each of the two groups. Results demonstrated an association between haemoglobin increment, fever and inflammatory mediators. Febrile patients had a significantly lower corrected Hb increment compared to nonfebrile patients, when adjusting for mediators. When fever was kept constant, a significant negative association between haemoglobin increment and the proinflammatory mediators IL-6 and IL-8 was observed.
Both fever and the inflammatory mediators IL-6 and IL-8 were negatively associated with post-transfusion haemoglobin increment.
在之前的一项初步研究中，我们发现与无发热患者相比，发热患者红细胞（RBC）输血后血红蛋白（Hb）的增加显著更低。本研究的目的是探讨血液系统疾病患者炎症介质与输血后血红蛋白增加之间的关联。
本研究纳入了27例接受RBC输血的患者（8例女性，19例男性），中位年龄56岁。根据估计的患者血容量和输入的Hb量对每单位输血的Hb增加量进行校正。采用多重技术测定多种炎症介质。使用混合线性回归模型分析输血后血红蛋白增加、血浆炎症介质与患者特征之间的关联。
发热患者校正后的Hb增加显著更低，IL-6、IL-8、IL-10和G-CSF值显著升高，CCL5和CXCL10水平显著降低，输血前CRP水平显著更高。对于整个患者队列，输血前CRP水平与校正后的Hb增加之间存在显著关联，但在两组中的每一组内均无此关联。结果表明血红蛋白增加、发热与炎症介质之间存在关联。在对介质进行校正后，发热患者校正后的Hb增加显著低于非发热患者。当发热保持恒定时，观察到血红蛋白增加与促炎介质IL-6和IL-8之间存在显著的负相关。
发热以及炎症介质IL-6和IL-8均与输血后血红蛋白增加呈负相关。
