Immunomodulation Effect of Blood Transfusion
Condition: Incompatible Blood Transfusion; Immune Defect; Surgery
Study type: Observational

Summary: 
      An increasing number of publications have demonstrated that homologous (allogeneic) blood
      transfusion impairs outcome in cancer and non-cancer patients. Leukocyte depletion of blood
      products cannot solve these problems, despite improved quality of red cells; a recent study
      demonstrated deteriorated outcome of cancer patients with elective colon surgery and
      transfusion of leukocyte depleted allogeneic blood.
    

Detailed description: 
      All patients undergo the identical anesthesiological procedure, including premedication,
      general anesthesia with endotracheal intubation, monitoring and postoperative pain therapy
      and mobilization.Surgery is performed by the identical team performing a standardized
      technique.

      Transfusion regimen The 'trigger' for homologous red cell transfusion intra- and
      postoperatively is the actual hematocrit concentration. Transfusion depends on discretion of
      the treating physicians. Number of units transfused, amount of blood loss, time, reasoning
      and decision maker are recorded.

      Blood samples Within the kind of surgical procedures chosen for this study the chance of red
      cell transfusion is about 60 - 70%. In terms of figures 10 non-transfused cases could be
      gained within 40 cases in total. However, transfusion or non-transfusion does not happen in a
      row. We expect the total number of patients with blood withdrawal to be between 50 and 60.
      Additionally withdrawn samples currently not used for analysis will stored for further
      studies.

      The purpose to include non-transfused otherwise fully comparable patients is to distinguish
      between trauma (operation) and transfusion and their influence on immune modulation. Within
      the studies about blood transfusion and immune modulation only some few made this
      differentiation. In patients with colorectal cancer surgery randomized groups with autologous
      predonation and patients with allogeneic transfusion only have been compared. However, within
      the latter (allogeneic) group of 27 patients only 13 had to be transfused, thus creating a
      non-transfusion group of 14 patients. These 14 non-transfused patients remained within the
      study being compared with autologous and allogeneic transfused patients. Operative trauma and
      allogeneic transfusion both increased the secretion of several cytokines including tumor
      necrosis factor (TNF) alpha and Interleukin-10; this effect was less pronounced in patients
      with autologous- and without any transfusion. Another group studied forty three orthopedic
      patients with total knee- or hip-arthroplasty, initially to compare autologous to allogeneic
      red cell transfusion. They had to change their protocol due to the small number of allogeneic
      transfusions (8 of 43). Including perioperatively transfused patients only (n = 37) they
      found an increase in immune regulatory cytokine Interleukin (IL)-10 after red cell
      transfusion, which was most pronounced 7 days after surgery, whereas there was only a mild
      increase in non- or autologous transfused patients. Unfortunately they did not differentiate
      between autologous-and non-transfused patients. Thus their data could not reveal the effect
      of surgery itself on the analyzed parameters.
    

Intervention name(s): No blood transfusion; Day 0 blood transfusion; Day 1 or 2 blood transfusion
Intervention type(s): Biological; Biological; Biological
Intervention description(s): No blood transfusion; Patients undergoing elective spine surgery receiving intra- or immediate-postoperative red cell blood transfusion.; Patients undergoing elective spine surgery receiving first red cell blood transfusion on day 1 or 2 after surgery.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients undergoing elective spine surgery/
      
Biospecimen description: 
      Blood
    
Keywords: Blood transfusion; Immune; Surgery