Impact of Allogenic and Autologous Transfusion on Immune Function in Patients with Tumors

  • Guo, Jian-Rong ;
  • Xu, Feng ;
  • Jin, Xiao-Ju ;
  • Shen, Hua-Chun ;
  • Liu, Yang ;
  • Zhang, Yi-Wei ;
  • Shao, Yi
  • Published : 2014.01.15


Objective: To observe the effects of allogeneic and autologous transfusion on cellular immunity, humoral immunity and secretion of serum inflammatory factors and perforin during the perioperative period in patients with malignant tumors. Methods: A total of 80 patients (age: 38-69 years; body weight: 40-78 kg; ASA I - II) receiving radical operation for gastro-intestinal cancer under general anesthesia were selected. All the patients were divided into four groups based on the methods of infusion and blood transfusion: blank control group (Group C), allogeneic transfusion group (group A), hemodiluted autotransfusion Group (Group H) and hemodiluted autotransfusion + allogenic transfusion Group (A+H group). Venous blood was collected when entering into the surgery room ($T_0$), immediately after surgery ($T_1$) and 24h ($T_2$), 3d ($T_3$) and 7d ($T_4$) after surgery, respectively. Moreover, flow cytometry was applied to assess changes of peripheral blood T cell subpopulations and NK cells. Enzyme linked immunosorbent assays were performed to determine levels of IL-2, IL-10, TNF-${\alpha}$ and perforin. Immune turbidimetry was employed to determine the changes in serum immunoglobulin. Results: Both CD3+ and NK cells showed a decrease at $T_1$ and $T_2$ in each group, among which, in group A, CD3+ decreased significantly at $T_2$ (P<0.05) compared with other groups, and CD3+ and NK cell reduced obviously only in group A at $T_3$ and $T_4$ (P<0.05). CD4+ cells and the ratio of D4+/CD8+ were decreased in groups A, C and A+H at $T_1$ and $T_2$ (P<0.05). No significant intra- and inter-group differences were observed in CD8+ of the four groups (P<0.05). IL-2 declined in group C at $T_1$ and $T_2$ (P<0.05) and showed a decrease in group A at each time point (P<0.05). Moreover, IL-2 decreased in group A + H only at $T_1$. No significant difference was found in each group at $T_1$ (P<0.05). More significant decrease in group ?? at $T_2$, $T_3$ and $T_4$ compared with group A (P<0.05), and there were no significant differences among other groups (P>0.05). IL-10 increased at $T_1$ and $T_2$ in each group (P<0.05), in which it had an obvious increase in group A, and increase of IL-10 occurred only in group A at $T_3$ and $T_4$ (P<0.05). TNF-${\alpha}$ level rose at $T_1$ (P<0.05), no inter- and intra-group difference was found in perforin in all groups (P<0.05). Compared with the preoperation, both IgG and IgA level decreased at $T_1$ in each group (P<0.05), and they declined only in Group A at $T_2$ and $T_3$ (P<0.05), and these parameters were back to the preoperative levels in other groups. No significant differences were observed between preoperative and postoperative IgG and IgA levels in each group at $T_4$ (P>0.05). No obvious inter- and intra-group changes were found in IgM in the four groups (P>0.05). Conclusions: Allogeneic transfusion during the perioperative period could obviously decrease the number of T cell subpopulations and NK cells and the secretion of stimulating cytokines and increase the secretion of inhibiting cytokines in patients with malignant tumors, thus causing a Th1/Th2 imbalance and transient decreasing in the content of plasma immune globulin. Autologous transfusion has little impact and may even bring about some improvement oo postoperative immune function in patients with tumors. Therefore, cancer patients should receive active autologous transfusion during the perioperative period in place of allogeneic transfusion.


Allogeneic transfusion;autologous transfusion;malignant tumor;immunity


  1. Pintaric M, Gerner W, Saalmuller A (2008). Synergistic effects of IL-2, IL-12 and IL-18 on cytolytic activity, perforin expression and IFN-gamma production of porcine natural killer cells. Vet Immunol Immunopathol, 121, 68-82.
  2. Pipkin ME, Sacks JA, Cruz-Guilloty F, et al (2010). Interleukin-2 and inflammation induce distinct transcriptional programs that promote the differentiation of effector cytolytic T cells. Immunity, 32, 79-90.
  3. Rajbhandary S, Zhao MF, Zhao N, et al (2013). Multiple cytotoxic factors involved in IL-21 enhanced antitumor function of CIK cells signaled through STAT-3 and STAT5b pathways. Asian Pac J Cancer Prev, 14, 5825-31.
  4. Schmidt NW, Khanolkar A, Hancox L, et al (2012). Perforin plays an unexpected role in regulating T-cell contraction during prolonged Listeria monocytogenes infection. Eur J Immunol, 42, 629-40.
  5. Sparrow RL (2010). Red blood cell storage and transfusionrelated immunomodulati-on. Blood Transfus, 3, 26-30.
  6. Vamvakas EC, lajchman MA (2007). Transfusion-related immunomodulation (TRIM): An update. Blood Rev, 21, 327-38.
  7. Voskoboinik I, Dunstone M A, Baran K, et al (2010). Perforin: structure, function, and role in human immunopathology. Immunol, 235, 35-54.
  8. Wang WJ, Tao Z, Gu W, et al (2013). Variation of blood T lymphocyte subgroups in patients with non-small cell lung cancer. Asian Pac J Cancer Prev, 14, 4671-3.
  9. Lopez TV, Lappin TR, Maxwell P, et al (2011). Autocrine/ paracrine erythropoietin signalling promotes JAK/STATdependent proliferation of human cervical cancer cells. Int J Cancer, 129, 2566-76.
  10. Kourea K, Parissis JT, Farmakis D, et al (2008). Effects of darbepoetin-alpha on plasma pro-inflammatory cytokines, anti-inflammatory cytokine interleukin-10 and soluble Fas/ Fas ligand system in anemic patients with chronic heart failure. Atherosclerosis, 199, 215-21.
  11. Leal-Noval SR, Munoz-Gomez M, Arellano V, et al (2010). Influence of red blood cell transfusion on $CD4^{+}$ T-helper cells immune response in patients undergoing cardiac surgery. J Surg Res, 164, 43-9.
  12. Liu ZM, Wang YB, Yuan XH. (2013). Exosomes from murinederived GL26 cells promote glioblastoma tumor growth by reducing number and function of $CD8^{+}$ T cells. Asian Pac J Cancer Prev, 14, 309-14.
  13. Meng J, Lu XB, Tang YX, et al (2013). Effects of allogeneic blood transfusion in patients with stage II colon cancer. Asian Pac J Cancer Prev, 14, 347-50.
  14. Ojima T, Iwahashi M, Nakamori M, et al (2009). Association of allogeneic blood transfusions and long-term survival of patients with gastric cancer after curative gastrectomy. Gastrointest Surg, 13, 1821-30.
  15. Pandey P, Chaudhary R, Aggarwal A, et al (2010). Transfusionassociated immunomodulation: Quantitative changes in cytokines as a measure of immune responsiveness after one time blood transfusion in neurosurgery patients. Asian J Transfus Sci, 4, 78-85.
  16. Piao YR, Piao LZ, Zhu LH, et al (2013). Prognostic value of T cell immunoglobulin mucin-3 in prostate cancer. Asian Pac J Cancer Prev, 14, 3897-901.
  17. Piconese S, Valzasina B, Colombo MP, et al (2008). Triggering blocks suppression by regulatory T cells and facilitates tumor rejection. J Exp Med, 205, 825-39.
  18. De Oliveira GS Jr, Schink JC, Buoy C, et al (2011). The association between allogeneic perioperative blood transfusion on tumour recurrence and survival in patients with advanced ovarian cancer. Transfus Med, 11, 1111-41
  19. Bogdan C (2011). Regulation of lymphocytes by nitric oxide. Methods Mol Biol, 677, 375-93.
  20. Boyman O, Sprent J (2012). The role of interleukin-2 during homeostasis and activation of the immune system. Nat Rev Immunol, 12, 180-90.
  21. Brudvik KW, Tasken K (2011). Modulation of T cell immune functions by the prostaglandin E(2)-cAMP pathway in chronic inflammatory states. Br J Pharmacol, 5, 411-9.
  22. Han CB (2011). Effect of immunoglobulin on autologous blood transfusion in patient with colocectal cancer. J Clin Hematol, 24, 597-8.
  23. Hendrickson JE, Hillyer CD (2009). Noninfectious serious hazards of transfusion. Anesth Analg, 108, 759-69.
  24. Hod E A, Zhang N, Sokol SA, et al (2010). Transfusion of red blood cells after prolonged storage produces harmful effects that are mediated by iron and inflammation. Blood, 115, 4284-92.
  25. Holt D, Ma X, Kundu N, et al (2011). Prostaglandin E(2) (PGE (2)) suppresses natural killer cell function primarily through the PGE(2) receptor EP4. Cancer Immunol Immunother, 60, 1577-86.
  26. Howell WM, Rose-Zerilli MJ (2007). Cytokine gene polymorphisms, cancer susceptibility, and prognosis. J Nutr, 137, 194S-9S.
  27. Jin BQ (2009). A major breakthrough in T-B cells and collaborative study of follicular helper T cells, a new $CD4^{+}$ effect of T cell subsets. Chin J Cell Mol Immunol, 25, 1-5.
  28. Balkwill F (2009). Tumour necrosis factor and cancer. Nat Rev Cancer, 9, 361-71.
  29. Barnett CC, Beck AW, Holloway SE, et al (2010). Intravenous delivery of the plasma fraction of stored packed erythrocytes promotes pancreatic cancer growth in immuno-competent mice. Cancer, 116, 3862-74.
  30. Bernard AC, Davenport DL, Chang PK, et al (2009). Intraoperative transfusion of 1 U to 2 U packed red blood cells is associated with increased 30-day mortality, surgicalsite infection, pneumonia, and sepsis in general surgery patients. Am Coll Surg, 208, 931-7.

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Supported by : Pudong Health Bureau of Shanghai