Studies reporting a relationship between infectious complications and the transfusions of allogeneic blood products.

Autologous Blood and Postoperative Infection

Postoperative infections appear to be related to the transfusion of allogeneic blood as opposed to autologous blood as shown in studies by Triulzi et al³ and Vignali et al.¹⁰

Autologous blood is not associated with infectious complications in spinal surgery patients.

For Colorectal Surgery Patients, Infection Rates Rise with Allogeneic Transfusions

Multivariate analysis identified allogeneic blood transfusion as the only variable related to the occurrence of postoperative infections in colorectal surgery patients.

Although it was initially thought that the dose response relationship between transfusions and infection required many units of blood, Vignali et al demonstrated that postoperative infection rates in colorectal surgery patients are significantly increased even for patients transfused with 1 to 5 units.¹⁰

Dose-Response for Transfusion and Infection in Colorectal Surgery Patients

Patients transfused with 1-5 units have infectious complication rates averaging 27%.¹⁰

The administration of a single unit of allogeneic blood is associated with a significant increased risk of postoperative infection in colorectal surgical patients¹⁰ as shown in other types of surgical patients.³

A Single Allogeneic Transfusion

Patients receiving a single transfused allogeneic unit had a 25% incidence of infection compared to 6.7% for patients receiving no transfusion.¹⁰

Historically, blood transfusions have been used to ensure successful renal transplant¹¹ and transfused leukocytes were identified as key immunosuppressive components in blood. Leukocyte reduced blood was unable to exert this “transfusion effect”. Gianotti et al further validated leukocytes as key immunosuppressive components in blood in their animal model study. The results demonstrated that exposure to leukocytes causes the greatest mortality in mice that are burned and given E. coli by gavage. A dose-response relationship between the number of leukocytes transfused and survival was demonstrated.¹²

Leukocytes Dose-Response for the Immunosuppression Effect

Adapted from Gianotti et al showing leukocytes effect on immunosuppression. Induced mortality following swabbing of a burn injury with a suspension of E. coli.12

Leukocytes are present in all blood components and they are unintentionally transfused along with the intended product. The distribution of leukocytes that contaminate various blood components is shown below.

The high rate of infection seen among colorectal surgery patients transfused with allogeneic blood was corroborated by Jensen et al. Their data emphasize that the immunosuppressive effect of transfusion is mediated by leukocytes. Jensen et al showed when leukocyte reduced blood was transfused, infection rates fell from 23% to 3%, the identical rate seen in non-transfused patients.

High Infection Rates are Lower When Leukocyte Reduced Blood is Used

Adapted from Jensen et al.⁶

Leukocyte reduced blood lowers the infection rate. Jensen et al in their most recent study published in Lancet demonstrated that in colorectal surgery patients, allogeneic blood transfusion was associated with a high frequency of postoperative infection. Patients receiving leukocyte reduced blood had a low frequency of infection similar to patients who were not transfused.¹⁴

Jensen and colleagues strongly recommend leukocyte reduced blood for all patients undergoing colorectal surgery who require transfusion.¹⁴

In colorectal surgery patients, the easiest way to reduce the cost of hospital care is to reduce the length of hospital stay (LOS). Room and board account for the majority of the expense of surgical care, and length of stay is highly correlated with the overall cost of hospitalization.

Tartter found that blood transfusion was significantly related to LOS independent of operative procedure, age of patient, and complications.¹⁵

Allogeneic Blood Transfusion is a Key Cost Driver in Colorectal Surgery Patients

Adapted from Tartter.15

Tartter found transfused patients stayed 5.2 days longer than untransfused patients.¹⁵

Jensen and coworkers confirmed a similar reduction in hospital stay of 6 days, as Tartter reported on transfused patients, by providing patients with leukocyte reduced transfusion products. This provided a 36% reduction in patient charges.¹⁶

• No transfusion
• Autologous transfusion and blood sources
• Leukocyte reduced blood components ^3,17

High efficiency leukocyte reducing filters can provide leukocyte reduced blood components with residual leukocyte counts significantly below the most stringent standards.¹⁸ These leukocyte reduced blood components serve as an integral tool in the management of surgical transfusion by providing a product with a higher safety profile,¹⁹ as well as one that minimizes postoperative complications to assure timely patient recovery and discharge.

• Allogeneic blood transfusions are immunosuppressive and increase the risk of infection and length of hospital stay in colorectal surgical patients, as well as other surgical patients.
  
  
• Donor leukocytes contaminating all blood components are key immunosuppressive agents in transfused blood.
  
  
• Removal of donor leukocytes by filtration is a clinically proven method to reduce the morbidity rate in colorectal and other surgical patients.
  
  
• Leukocyte reduced blood components may prevent costly infectious complications.
  

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3. Triulzi DJ, Vanek K, Ryan DH and Blumberg N: A clinical and immunologic study of blood transfusion and postoperative bacterial infection in spinal surgery. Transfusion 1992; 32:517-524.
   
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13. Data on file at Pall Corporation, East Hills, NY.
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15. Tartter P: Determinants of postoperative stay in patients with colorectal cancer implications for diagnostic-related groups. Dis Colon Rectum 1988; 31:694-698.
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17. Jensen LS, Kissmeyer-Nielsen P, Wolff B, Qvist N: Postoperative infection after colorectal surgery. Lancet 1996; 348:1665-1666.
18. Data on file at Pall Corporation, East Hills, NY.
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