Immunologic changes after transfusion of autologous or allogeneic buffy coat‐poor versus WBC‐reduced blood transfusions in patients undergoing arthroplasty.II. Activation of T cells, macrophages, and cell‐mediated lympholysis

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Abstract
BACKGROUND: To estimate the impact of RBC preparations on the status of postoperative immune activation, the soluble cytokine receptors of TNFα (sTNF‐R) and IL‐2 (sIL‐2R), as well as neopterin and cell‐mediated lympholysis (CML), were measured. STUDY DESIGN AND METHODS: Patients undergoing strictly standardized anesthesiologic management for elective orthopedic surgery were enrolled in a prospective study. The perioperative course (Days 0, 3, 7, and 10) of sTNF‐R, sIL‐2R, neopterin, and CML was compared after random assignment to allogeneic buffy coat‐reduced (Group 2, n = 8) or WBC‐reduced (Group 3, n = 11) RBC transfusion regimen. Recipients of autologous buffy coat‐reduced RBC transfusions (Group 1, n = 15) served as controls. Patients receiving intraoperatively and postoperatively salvaged blood only (n = 10) were separately analyzed as Group 4. RESULTS: In Group 1, a short‐lasting increase in soluble cytokine receptors, a diminished cytolytic response (Day 0 vs. Day 7: sTNF‐R, p = 0.0001; sIL‐2R, p = 0.0004; CML, p = 0.0238), and an elevation of neopterin (Day 0 vs. Day 3: p = 0.0064) were observed. In contrast, in allogeneically transfused patients, sTNF‐R (Group 2, p = 0.0469: Group 3, p = 0.0039), sIL‐2R (Group 3, p = 0.002) and neopterin (Group 3, p = 0.0164) increased further from baseline to Day 10 (Day 0 vs. Day 10), and this increase was accompanied by a diminished cytolytic response (Day 0 vs. Day 10: Group 2, p = 0.05; Group 3, p = 0.0076). Patients in Group 4 showed a short‐lasting increase in sIL‐2R (Day 0 vs. Day 3: p = 0.0078), neopterin (Day 0 vs. Day 3: p = 0.0156) and sTNF‐R (Day 0 vs. Day 7: p = 0.0781). CONCLUSION: Allogeneic transfusions seem to prolong the postoperative status of immune activation, even when WBC‐filtered RBCs are used for the transfusion regimen.