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Review
. 2017 Nov;24(6):551-557.
doi: 10.1097/MOH.0000000000000376.

Transfusion-related immunomodulation: a reappraisal

Lyla A Youssef  1 , Steven L Spitalnik
Affiliations
Review

Transfusion-related immunomodulation: a reappraisal

Lyla A Youssef et al. Curr Opin Hematol. 2017 Nov.

Abstract

Purpose of review: This review summarizes current and prior observations regarding transfusion-related immunomodulation (TRIM) and puts these ideas into a modern immunological context, incorporating concepts from innate, adaptive, and nutritional immunity. We propose that TRIM research focus on determining whether there are specific, well-defined immunosuppressive effects from transfusing 'pure' red blood cells (RBCs) themselves, along with the by-products produced by the stored RBCs as a result of the 'storage lesion.' Macrophages are a key cell type involved in physiological and pathological RBC clearance and iron recycling. The plasticity and diversity of macrophages makes these cells potential mediators of immune suppression that could constitute TRIM.

Recent findings: Recent reports identified the capacity of macrophages and monocytes to exhibit 'memory.' Exposure to various stimuli, such as engulfment of apoptotic cells and interactions with ß-glucan and lipopolysaccharide, were found to induce epigenetic, metabolic, and functional changes in certain myeloid cells, particularly macrophages and monocytes.

Summary: Macrophages may mediate the immunosuppressive aspects of TRIM that arise as a result of transfused RBCs and their storage lesion induced by-products.

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Conflict of interest statement

3. Conflicts of interest: Ms. Youssef has no conflicts of interest to declare. Dr. Spitalnik is a Consultant for the New York Genome Center, a member of advisory boards for Tioma Therapeutics, Theranos, NewHealth Sciences, and BloodWorks Northwest, and the CEO of Ferrous Wheel Consultants, LLC. However, Dr. Spitalnik does not believe that any of these perceived conflicts of interest are relevant to this submitted manuscript.

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