Blood Transfusions and Immune Response

The Impact of Lowering Transfusion Trigger on Patient Immune Response During Major Abdominal Surgery

• We have previously reported the results of the primary and secondary outcomes of a randomized study aiming to investigate the impact of a restrictive transfusion protocol on the magnitude of reduction in blood transfusion in a typically mixed general surgery population subjected to major abdominal surgery.
• The main finding of that study was a reduction in red blood cell usage with the implementation of a restrictive transfusion regimen. This was achieved without adversely affecting clinical outcome in the population studied.
• The aim of this secondary analysis performed on a subgroup of 20 patients from the original study was to determine whether there are any differences in the postoperative immunologic response, as expressed by the production of inflammatory mediators, between a restrictive approach to red cell transfusion and a more liberal strategy.

Inclusion Criteria:

• Adult patients, American Society of Anesthesiologists (ASA) distribution I-III, scheduled for elective upper major abdominal surgery

Exclusion Criteria:

• history of bleeding diathesis
• hereditary hemostatic defects such as hemophilias
• chronic anticoagulant administration
• refusal of transfusions for religious reasons
• ischemic heart disease (unstable angina or myocardial infarction within the last six months)
• preexisting infectious diseases
• preexisting autoimmune diseases
• use of corticosteroids or immunosuppressive drugs within the last six months