Immunomodulatory Effects of Non-Leukocyte-Depleted and Leukocyte-Depleted Autologous Blood

Background: Based on several in vitro experiments, it has been suggested that autologous blood transfusion might lead to immunomodulation and that this effect might be prevented by leukocyte depletion. Clinical studies with surrogate endpoints showed conflicting results, whereas studies documenting clinically relevant outcomes were either too small or methodologically suboptimal to answer this question. Patients and Methods: Participants of a randomized multicenter trial were studied. Patients were scheduled for total hip arthroplasty and preoperative autologous blood donation (PABD) of 2 or more autologous whole blood units. Immunological parameters were investigated prior to first donation, prior to surgery and on days 1, 5, and 10 after surgery. Results: Leukocyte and lymphocyte subsets changed slightly after donation and considerably after surgery. Monocyte function was slightly suppressed following donation and substantially impaired after surgery. Transfusion slightly counteracted this effect. Leukocyte depletion did not result in any significant changes of the investigated immunological parameters. Conclusion: Following PABD immunological changes in patients occur that can be attributed mainly to the donation process and surgery. Transfusion has a minor effect. Leukocyte depletion does not appear to contribute substantially to these changes. Schlüsselwörter Präoperative Eigenblutspende · Autologe Transfusion · Transfusionsassoziierte Immunmodulation · Leukozytendepletion