Effects of intraoperative autologous and heterologous blood transfusions on humoral immune response

Blood transfusion has led to transmisson of infectious diseases (i.e. HIV, hepatit B and C), immunosupression, acute lung injury associated with transfusion, transfusion reactions, graft-versus-host reactions and some repercussions which are stil unclear . Avoidance of allogeneic transfusion due to both it?s unexpected effects and restricted sources has led to seeking alternative methods. Preoperative autologous donation, perioperaitve cell-salvage techniques, controlled hypotension and pharmacologic applications have been developed. Among these techniques Acute Normovolemic Hemoduliton (ANH) is employed by anesthesiologists .In total hip and knee surgery in which blood transfusions are necessary, the autologous blood transfusion has been adminestered to preventing unexpected reactions and complications related to intraoperative blood transfusions .In our study, it was aimed that the determination of effects of intraoperative autologous and heterologous blood transfusions on humoral immune response with values of TNF ?, IL6 and C3a before surgery, end of surgery and in postoperative third day in patient subjected to hip and knee prosthesis.In this research, 30 patients (their ages were between 20 and 70 and in ASA I-II group) which were subjected to hip and knee prosthesis and were verbally and nominally acquainted and approved with approval of Afyon Kocatepe University Medical Ethics Council were investigated. Patients with aort stenosis, angina, coronary artery disease, heart disease, diabetes mellitus, renal dysfunction, uncontrolled hypertension, epylepsi or previously blood transfusion adminestered and pregnants were not investigated.The patients were randomizedly seperated to two groups as autologous blood transfusion (Group 1) and heterologous blood transfusion (Group 2). Acute normovolemic hemodultion method was applied to Group 1 patients which will receive autologous blood transfusion. Just after anesthesia induction in group 1, blood collected to bag from one arm of patient and colloid solutions in a equal volume was added to blood collected from other arm at the same time.Crystalloid, colloid liquids and autologous/heterologous bloods was adminesterd to patients according to blood loses and blood gas result. Blood loses was calculated with observing of aspiration unit, sponge and surgery area. The patients was observed in point of complications until discharged from a hospital. C3a, IL-6 and TNF-a levels was measured before operation, end of operation and at postoperative third day in blood sapmles collected from all cases.Using SPSS for Windows 11.5, descriptive test for demographic data, Chi Square, Independent Simple T and Parient Simple T tests for distribution of data and evaluation of homogeneity, T-test for data appropriate to normal distribution in anesthesic, hemodynamic scores and Mann Whitney U test for other data was analized. Chi Square and Fisher?s Exact tests were used to comparing percentages. Meaningfulness level was accepted as P<0.05.There was no differences between groups in point of blood gas parameters of demography, hemodynamic and hemogram. In this study, decrease in rate of heterologous blood transfusion was detected; red blood cells, coagulation factors and platelets reinfused in autologous group. Since the red blood cells was diluted in circulatory system, there was few lose in blood element during surgery and tissue perfusion and oxygen supply to tissue was protected. Biochemical changes in stored blood were not observed in acute normovolemic hemodulition, moreover, transmission of transfüzyon related diseases, hemolitic and allergic reactions were not develop.In this study to evaluate the humoral immun response after blood transfusion, compleman activation with high C3 was marked at 0th day, while the two times increase of TNF?, IL-6 at 3th day was prognostic indicator of strong inflammatory response. It has showed that heterologous transfusion was constituted strong systemic inflammatory effect compared to autologous transfusion.