Impact of Postoperative Unwashed Shed Blood Retrieved after Total Knee Arthroplasty on Endotoxin-stimulated Tumor Necrosis Factor alpha Release In Vitro.

Anesthesiology
Munoz M, Munoz E, Navajas A, Campos A, Rius F, Gomez A
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BACKGROUND:: Allogeneic or autologous blood seems to have an immunosuppressive effect that is largely attributable to storage-dependent factors. However, transfusion of postoperative unwashed shed blood (USB) after elective total knee replacement does not undergo storage. Therefore, the authors explored the effects of USB on the mitogen-driven cytokine synthesis by the patient’s peripheral blood mononuclear cells. METHODS:: Perioperative blood samples were obtained from 12 total knee replacement patients with and 5 without reinfusion of leukoreduced USB, and from USB reinfusion line, before and after leukoreduction. Venous blood obtained at 4-6 postoperative hours was coincubated with USB. Endotoxin-stimulated release of tumor necrosis factor alpha and interleukin 10 was measured after 24 h of culture by solid-phase enzyme-labeled chemiluminescent immunometric assay. RESULTS:: Coincubation of postoperative venous blood with USB, USB cells, or USB plasma resulted in a significant depression of tumor necrosis factor-alpha synthesis, without significant effects on interleukin-10 synthesis. However, no differences were observed for endotoxin-stimulated cytokine release in perioperative blood samples from patients receiving or not receiving USB. CONCLUSION:: These data suggest that USB seemed to contain an antiinflammatory agent. However, at the actual retransfusion rate, USB does not seem to further enhance the immunosuppression that follows knee replacement surgery.