Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery

TLDR

In a prospective randomized trial of 197 elective colorectal surgery patients, researchers compared no transfusion, whole blood, or leucocyte‑free filtered blood groups and measured natural killer cell activity pre‑op and at 3, 7, and 30 days post‑op. Whole‑blood transfusion was associated with a 23 % postoperative infection rate and sustained NK cell impairment, whereas filtered blood and no transfusion groups had only 2 % infections, supporting avoidance of whole blood transfusion.

Abstract

Abstract The frequency of infection in 197 patients undergoing elective colorectal surgery and having either no blood transfusion, transfusion with whole blood, or filtered blood free from leucocytes and platelets was investigated in a prospective randomized trial. Natural killer cell function was measured before operation and 3, 7 and 30 days after surgery in 60 consecutive patients. Of the patients 104 required blood transfusion; 48 received filtered blood and 56 underwent whole blood transfusion. Postoperative infections developed in 13 patients transfused with whole blood (23 per cent, 9.5 per cent confidence interval 13–32 per cent), in one patient transfused with blood free from leucocytes and platelets (2 per cent, 9.5 per cent confidence interval 0.05–11 per cent) and in two non-transfusedpatients (2 per cent, 95 per cent conjidence interval 0.3-8per cent) (P < 0.01). Natural killer cell function was significantly (P < 0.001) impaired up to 30 days after surgery in patients transfused with whole blood. These data provide a strong case against the use of whole blood transfusion in patients undergoing elective colorectal surgery.