Anesth Analg 2005;101:1889-1890
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000180280.63468.93
LETTER TO THE EDITOR
Allogeneic Blood Transfusion and Wound Healing Disturbance After Orthopaedic Surgery
Manuel Muñoz,
Elvira Bisbe,
José Antonio García-Erce, and
Jorge Cuenca
GIEMSA, School of Medicine, Málaga, Spain, mmunoz@uma.es (Muñoz)
Department of Anaesthesiology, Hospital Mar-Esperanza, Barcelona, Spain (Bisbe)
Department of Haematology (García-Erce)
Department of Orthopaedics, Hospital Miguel Servet, Zaragoza. Spain (Cuenca)
To the Editor:
We read with interest the article about the influence of perioperative allogeneic blood transfusion on wound healing disturbances after hip replacement surgery by Weber et al. (1). We wish to review some mechanisms by which the relationship allogeneic blood transfusion and wound healing disturbances might be connected, taking into account both the absolute number and the age of the transfused units.
On the one hand, the decrease in the ability of stored erythrocytes to deform and unload oxygen in the peripheral tissues, possibly favoring tissue ischemia, has been reported (2). In addition, the desialylation of erythrocytes during storage and the exposure of phosphatidylserine residues in the membrane outer leaflet make the erythrocytes more adherent to the inflamed endothelium at the wound site and convert it into a procoagulant surface, thus contributing to the alteration of microvascular blood flow (3). These changes are also signals of senescence and enhance erythrocyte phagocytosis by macrophages (3). This obviously uses part of the capacity of the phagocytic mononuclear system and may compete with infection defense with possible consequences (4), such as an increased rate of postoperative infection or positive wound cultures (1,5).
On the other hand, erythropoietin not only stimulates erythropoiesis but also angiogenesis and wound healing (6). However, erythropoietin synthesis, which is blunted by surgical trauma (7), may be further reduced by treatment of postoperative anemia with allogeneic blood transfusion (8), thus possibly contributing to wound healing disturbances.
References
- Weber EWG, Slappendel R, Prins MH, et al. Perioperative blood transfusions and delayed wound healing after hip replacement surgery: effects on duration of hospitalisation. Anesth Analg 2005;100:1416–21.[Abstract/Free Full Text]
- Muñoz M, Sánchez-Arrieta Y, García-Vallejo JJ, et al. Autotransfusión pre y postoperatoria: estudio comparativo de la hematología, bioquímica y metabolismo eritrocitario en sangre predonada y sangre de drenaje postoperatorio. Sangre 1999;44:433–50.
- Bratosin D, Leszczynski S, Sartiaux C, et al. Improved storage of erythrocytes by prior leukodepletion: flow cytometric evaluation of stored erythrocytes. Cytometry 2001;46:351–6.[Medline]
- Högman CF. Storage of blood components. Curr Opin Hematol 1999;6:427–31.[Medline]
- Rosencher N, Kerkkamp HEM, Macheras G, et al. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion 2003;43:459–69.[Web of Science][Medline]
- Buemi M, Galeano M, Sturiale A, et al. Recombinant human erythropoietin stimulates angiogenesis and healing of ischemic skin wounds. Shock 2004;22:169–73.[Web of Science][Medline]
- Biesma DH, Van De Wiel A, Beguin Y, et al. Post-operative erythropoiesis is limited by the inflammatory effect of surgery on iron metabolism. Eur J Clin Invest 1995;25:383–9.[Web of Science][Medline]
- Cazzola M, De Stefano P, Ponchio L, et al. Relationship between transfusion regimen and supresión of erythropoiesis in beta-thalassanemia major. Br J Haematol 1995;89:473–8.[Medline]
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