Understanding the Effect of Transfusion Rates on Differential Modulation of Inflammatory Responses.

INTRODUCTION

The immediate postinjury immune response contributes in a complex manner to trauma-induced coagulopathy. The necessary transfusion of blood components can further impact a patient's immune response, creating a poorly understood cycle of transfusion, inflammation, and coagulopathy. The purpose of this study is to define the relationship between large volume transfusion and variations in the immune response following injury.

METHODS

Utilizing the Pragmatic, Randomized Optimal Platelet and Plasma Ratios trial dataset, the time and volume of transfused blood products were compared to patients' inflammatory cascade for 72 h following injury. In order to model variations in the times and volumes of transfused blood products, time-varying effect modeling was used to assess cytokine response.

RESULTS

A total of 522 patients were included in the analysis. A statistically significant correlation in IL 6, IP 10, MIP 1B, and RANTES levels was observed in response to volume and tempo of blood product administration.

CONCLUSIONS

Cytokine levels in the acute post-traumatic period are related to blood product transfusion in a time- and volume-dependent manner, specifically showing increases in proinflammatory cytokine and chemokine signaling. An understanding of how blood product administration affects these cytokine signatures can help guide resuscitation practices and represents a potentially novel target for therapeutic intervention.