Intraoperative cell salvage: The impact on immune cell numbers

• Published in: PloS one 2023-08, Vol.18 (8), p.e0289177-e0289177
• Main Authors: Roets, Michelle, Sturgess, David, Tran, Thu, Obeysekera, Maheshi, Perros, Alexis, Tung, John-Paul, Flower, Robert, van Zundert, Andre, Dean, Melinda
• Format: Article
• Language: English
• Subjects: Adhesion; Analysis; Anesthesia; Biology and Life Sciences; Biomarkers; Blood & organ donations; Blood cells; Blood transfusion; CD11c antigen; CD123 antigen; CD14 antigen; CD20 antigen; CD25 antigen; CD3 antigen; CD38 antigen; CD4 antigen; CD56 antigen; CD8 antigen; CD80 antigen; CD83 antigen; CD86 antigen; CD9 antigen; Cells; Clinical outcomes; Comparative analysis; Complications and side effects; Cytokines; Cytotoxicity; Dendritic cells; Disease susceptibility; Effector cells; Erythrocytes; Ethics; Health aspects; Immune response; Immune system; Immunology; Infections; Intensive care; Leukocytes; Lymphocytes; Lymphocytes B; Lymphocytes T; Medical research; Medicine and Health Sciences; Medicine, Experimental; Microbiology; Mortality; Neutrophils; Orthopedics; Pathogenesis; Pathogens; Patient outcomes; Patients; Phlebotomy; Population studies; Populations; Research and Analysis Methods; Sepsis; Statistics; Surgery; Transfusion; Urinary tract infections; Wound infection
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0289177

Patient outcomes are influenced by many confounding factors peri-operatively, including the type of surgery, anaesthesia, transfusion, and immune competence. We have previously demonstrated (in-vitro) that compared to allogeneic blood transfusion (ABT), intraoperative cell salvage (ICS) improves immune competence. The peri-operative immune response is complex. Altered or impaired immune responses may predispose patients to develop adverse outcomes (i.e., post-operative wound infection, pneumonia, urinary tract infection etc.) Surgical patients may develop infection, even without the confirmed presence of a definite microbiological pathogen. With all these factors in mind it is important to consider changes in immune cell numbers (and sub-populations) and functional capacity during peri-operative transfusion. In this TRIMICS-Cell (Transfusion Related Immune Modulation and Intraoperative Cell Salvage-Cell numbers) study (n = 17, October 2018-November 2019) we prioritized and analysed peri-operative changes in the number and proportions of immune cell populations and sub-populations (B cells (CD20+), NK (natural killer) cells (CD56+), monocytes (CD14+), T cells (total CD3+ and sub-populations: T helper cells (CD4+), cytotoxic T cells (CD8+), effector T cells (CD4+ CD127+), activated effector T cells (CD4+ CD25+ CD127+) and regulatory T cells (CD4+ CD25+ CD127-)), plasmacytoid dendritic cells (pDC; Lineage-, HLA-DR+, CD11c-, CD123+), classical dendritic cell (cDC) (Lineage-, HLA-DR+, CD11c+), and cDC activation (Lineage-, HLA-DR+, CD11c+), co-stimulatory/adhesion molecules and pDC (CD9+, CD38+, CD80+, CD83+, CD86+, CD123+). Firstly we analysed the whole cohort of study patients and secondly according to the relevant transfusion modality (i.e., three study groups: those who received no transfusion, received ICS only (ICS), or both ICS and allogeneic packed red blood cells (pRBC) (ICS&RBC)), during major orthopaedic surgery. For the whole study cohort (all patients), changes in immune cell populations were significant: leucocytes and specifically neutrophils increased post-operatively, returning towards pre-operative numbers by 48h post-operatively (48h), and lymphocytes reduced post-operatively returning to pre-operative numbers by 48h. When considering transfusion modalities, there were no significant peri-operative changes in the no transfusion group for all immune cell populations studied (cell numbers and proportions (%)). Significant changes in cell popula