The impact of two different transfusion strategies on patient immune response during major abdominal surgery: A preliminary report

Blood transfusion is associated with well-known risks. we investigated the difference between a restrictive versus a liberal transfusion strategy on the immune response,as expressed by the production of inflammatory mediators,in patients subjected to major abdominal surgery procedures. fifty-eight patients undergoing major abdominal surgery were randomized preoperatively to either a restrictive transfusion protocol or a liberal transfusion protocol (with transfusion if hemoglobin dropped below 7.7 g dl-1 or 9.9 g dl -1,respectively). in a subgroup of 20 patients randomly selected from the original allocation groups,blood was sampled for measurement of il-6,il-10,and tnfα. postoperative levels of il-10 were higher in the liberal transfusion group on the first postoperative day (49.82 ± 29.07 vs. 15.83 ± 13.22 pg ml-1,p < 0.05). peak postoperative il-10 levels correlated with the units of blood transfused as well as the mean duration of storage and the storage time of the oldest unit transfused (r 2 = 0.38,p = 0.032,r2 = 0.52,p = 0.007,and r 2 = 0.68,p < 0.001,respectively). il-10 levels were elevated in patients with a more liberal red blood cell transfusion strategy. the strength of the association between anti-inflammatory il-10 and transfusion variables indicates that il-10 may be an important factor in transfusion-associated immunomodulation. this trial is registered under clinicaltrials.gov identifier: nct02020525. © 2014 kassiani theodoraki et al.