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Transfusion associated microchimerism: a heretofore little recognized complication following transfusion

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Abstract

Potent antiplatelet and antithrombotic agents have significantly reduced mortality in the setting of acute coronary syndromes and percutaneous coronary intervention. However these agents are associated with increased bleeding which is in turn associated with adverse clinical outcomes. In many centers, transfusion is often used to correct for blood loss. Blood transfusion in the setting of acute coronary syndrome has been associated with adverse clinical outcomes including increased mortality. Transfusion associated microchimerism (TA-MC) is a newly recognized complication of blood transfusion. There is engraftment of the donor’s hematopoietic stem cells in patients who then develop microchimerism. This article discusses the association of bleeding/blood transfusion with adverse outcomes and the potential role of TA-MC in clinical outcomes.

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Abbreviations

ACS:

Acute coronary syndrome

ACUITY:

Acute catheterization and urgent intervention triage strategy

ASSENT:

Assessment of the safety and efficacy of a new thrombolytic regimen

CABG:

Coronary artery bypass surgery

CLARITY:

Clopidogrel as adjunctive reperfusion therapy

COMMIT:

Clopidogrel and metoprolol in myocardial infarction trial

CURE:

Clopidogrel in unstable angina to prevent recurrent events trial

EPIC:

Evaluation of c7E3 for prevention of ischemic complications

EPILOG:

Evaluation in PTCA to improve long-term outcome with abciximab GP IIb/IIIa blockade

ESPRIT:

Enhanced suppression of the platelet IIb/IIIa receptor with integrilin therapy

ESSENCE:

Efficacy and safety of subcutaneous enoxaparin in non-Q-wave coronary events trial

EXTRACT:

Enoxaparin and thrombolysis reperfusion for acute myocardial infarction treatment

GRACE:

Global registry of acute coronary events

GUSTO:

Global utilization of streptokinase to open occluded arteries

GvHD:

Graft versus host disease

Hb:

Hemoglobin

HERO:

Hirulog and early reperfusion or occlusion

HIV:

Human immunodeficiency virus

HORIZONS:

Harmonizing outcomes with revascularization and stents

IL:

Interleukin

MI:

Myocardial infarction

NSTEMI:

Non ST elevation myocardial infarction

OASIS:

Organization to assess strategies for ischemic syndromes

PCI:

Percutaneous coronary intervention

PCR:

Polymerase chain reaction

PURSUIT:

Platelet glycoprotein IIB/IIIA in unstable angina: receptor suppression using integrilin therapy

REPLACE:

Randomized evaluation in PCI linking angiomax to reduced clinical events

STEEPLE:

Safety and efficacy of enoxaparin in PCI patients, an international randomized evaluation

STEMI:

ST elevation myocardial infarction

SYNERGY:

Superior yield of the new strategy of enoxaparin, revascularization and glycoprotein IIb/IIIa inhibitors trial

TAMC:

Transfusion associated microchimerism

TIMI:

Thrombolysis in myocardial infarction

TNF:

Tumor necrosis factor

TRITON:

Trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-thrombolysis in myocardial infarction-38

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Authors and Affiliations

  1. Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 350 Longwood Avenue, First Floor, Boston, MA, 02115, USA

    Vijayalakshmi Kunadian, Cafer Zorkun, William J. Gibson, Navin Nethala, Caitlin Harrigan, Alexandra M. Palmer, Katherine J. Ogando, Leah H. Biller, Erin E. Lord, Scott P. Williams, Michelle E. Lew, Lauren N. Ciaglo, Jacqueline L. Buros, Susan J. Marble & C. Michael Gibson

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  1. Vijayalakshmi Kunadian
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Correspondence to C. Michael Gibson.

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The authors have received research grant support and consulting fees in the past from Eli Lilly, Schering Plough, and Astra Zeneca.

Dr. Vijayalakshmi Kunadian has received unrestricted educational research grant support from South Cleveland Heart Fund, The James Cook University Hospital, Middlesbrough, United Kingdom.

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Kunadian, V., Zorkun, C., Gibson, W.J. et al. Transfusion associated microchimerism: a heretofore little recognized complication following transfusion. J Thromb Thrombolysis 27, 57–67 (2009). https://doi.org/10.1007/s11239-008-0268-0

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