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Review
. 2018 Mar;58(3):804-815.
doi: 10.1111/trf.14488. Epub 2018 Jan 30.

Mechanisms of red blood cell transfusion-related immunomodulation

Kenneth E Remy  1 , Mark W Hall  2   3 , Jill Cholette  4 , Nicole P Juffermans  5 , Kathleen Nicol  6 , Allan Doctor  1 , Neil Blumberg  7 , Philip C Spinella  1 , Philip J Norris  8   9 , Mary K Dahmer  10 , Jennifer A Muszynski  2   3 ; Pediatric Critical Care Blood Research Network (Blood Net)
Affiliations
Review

Mechanisms of red blood cell transfusion-related immunomodulation

Kenneth E Remy et al. Transfusion. 2018 Mar.

Abstract

Red blood cell (RBC) transfusion is common in critically ill, postsurgical, and posttrauma patients in whom both systemic inflammation and immune suppression are associated with adverse outcomes. RBC products contain a multitude of immunomodulatory mediators that interact with and alter immune cell function. These interactions can lead to both proinflammatory and immunosuppressive effects. Defining clinical outcomes related to immunomodulatory effects of RBCs in transfused patients remains a challenge, likely due to complex interactions between individual blood product characteristics and patient-specific risk factors. Unpacking these complexities requires an in-depth understanding of the mechanisms of immunomodulatory effects of RBC products. In this review, we outline and classify potential mediators of RBC transfusion-related immunomodulation and provide suggestions for future research directions.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors have disclosed no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Proposed mechanisms of RBC TRIM. RBC units contain multiple immunomodulatory mediators, including WBC-derived, RBC-derived, PLT-derived, and lipid and microvesicle–derived factors. Effects of these mediators on immune cell function vary and include both inflammatory and immunosuppressive changes. As such, the sum total immunomodulatory effects of RBC transfusion on recipient immune function will likely vary based on individual unit and recipient characteristics
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