Balance Between the Proinflammatory and Anti-Inflammatory Immune Responses with Blood Transfusion in Sepsis.
Teresa C Rice, Amanda M Pugh, Charles C Caldwell and 1 others
PMID 28778292WHAT IT FOUND
Transfusion in critically ill patients was described as shifting immune defenses toward suppression, with more units linked to higher anti-inflammatory signals.
Leukoreduction was reported to blunt some of this effect. This is a mechanistic review, not proof that transfusion worsens sepsis.
Key findings
01A report in transfused patients described a 70% reduction in IL-2, TNF-α, and IFN-γ.
02In the studies reviewed, leukoreduced transfusion was associated with lower post-transfusion infection risk and a reduced mortality increase.
03An absolute lymphocyte count of 0.6 cells per μl or less at four days after sepsis diagnosis was associated with secondary infections and mortality.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a narrative review, not a systematic review or original study, so it does not describe how articles were chosen or how evidence was appraised. It reports associations, not tested effects of transfusion, leukoreduction, or lymphocyte monitoring on patient outcomes. Transfusion can mark sicker patients, so worse outcomes after transfusion may reflect the underlying illness rather than the blood itself. Several mechanistic findings come from animals, laboratory tests, or small clinical reports, which cannot establish what will happen in a septic ICU patient. The monitoring advice appears in the conclusion and is not shown to improve care or outcomes.
The easy way to misread this
Do not read this review as proof that transfusion worsens sepsis or as a reason to withhold needed blood. It does not compare transfusion strategies or test whether leukoreduction or lymphocyte monitoring improves outcomes, and transfusion itself is associated with greater illness severity.