Immunologic effects of trauma and transfusion

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Secondary infection is an important source of morbidity and mortality after severe traumatic injury, affecting up to 27% of patients requiring intensive care unit (ICU) level care and up to 34% of wounded military personnel.1–5 This high-infection burden highlights a need to understand posttrauma derangements in inflammation and immune function. Although severe traumatic injury induces a recognizable systemic inflammatory response, it is increasingly apparent that this inflammatory response is accompanied by a concurrent and significant immune suppression.6–12 In fact, both elevated markers of inflammation and measures of immune suppression are associated with adverse outcomes including nosocomial infection and mortality posttrauma.6,11,13,14 Mechanisms of trauma-induced immune dysregulation are complex, multifactorial, and are likely influenced by blood product transfusion. Blood product transfusion, although undoubtedly a lifesaving therapy for hemorrhagic shock, is nonetheless independently associated with nosocomial infection and mortality in traumatically injured patients—suggesting immunosuppressive effects of transfusion.15–19 Preclinical models likewise reveal that various blood products used for transfusion interact with and have the ability to significantly alter immune cell function.20 Understanding the potential contribution of blood product transfusion to perpetuation of immune dysregulation after severe traumatic injury remains an important step to enhancing transfusion safety in this highly vulnerable population.
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