Editing Blood transfusion (section)

=== Other ===
* A relationship between intra-operative blood transfusion and cancer recurrence has been observed in colorectal cancer.<ref>{{cite journal | vauthors = Cata JP, Wang H, Gottumukkala V, Reuben J, Sessler DI | title = Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions | journal = British Journal of Anaesthesia | volume = 110 | issue = 5 | pages = 690–701 | date = May 2013 | pmid = 23599512 | pmc = 3630286 | doi = 10.1093/bja/aet068 }}</ref> In lung cancer intra-operative blood transfusion has been associated with earlier recurrence of cancer, worse survival rates and poorer outcomes after lung resection.<ref>{{cite journal | vauthors = Wang T, Luo L, Huang H, Yu J, Pan C, Cai X, Hu B, Yin X | display-authors = 6 | title = Perioperative blood transfusion is associated with worse clinical outcomes in resected lung cancer | journal = The Annals of Thoracic Surgery | volume = 97 | issue = 5 | pages = 1827–37 | date = May 2014 | pmid = 24674755 | doi = 10.1016/j.athoracsur.2013.12.044 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Churchhouse AM, Mathews TJ, McBride OM, Dunning J | title = Does blood transfusion increase the chance of recurrence in patients undergoing surgery for lung cancer? | journal = Interactive Cardiovascular and Thoracic Surgery | volume = 14 | issue = 1 | pages = 85–90 | date = January 2012 | pmid = 22108935 | pmc = 3420304 | doi = 10.1093/icvts/ivr025 }}</ref> Suppression of the [[immune system]] by blood transfusion has been implicated as playing a role in more than 10 different [[cancer]] types, through mechanisms involving the innate and adaptive immune system.<ref name="Transfusion and Apheresis Science">{{cite journal | vauthors = Kormi SM, Seghatchian J | title = Taming the immune system through transfusion in oncology patients | journal = Transfusion and Apheresis Science | volume = 56 | issue = 3 | pages = 310–6 | date = June 2017 | pmid = 28651910 | doi = 10.1016/j.transci.2017.05.017 }}</ref> Five major mechanisms for this include the [[T Lymphocyte|lymphocyte-T]] set, myeloid-derived suppressor cells (MDSCs), [[tumor-associated macrophage]]s (TAMs), [[natural killer cells]] (NKCs), and [[dendritic cells]] (DCs). Blood transfusion may modulate the activity of [[antitumor]] [[CD8+]] [[cytotoxic T lymphocytes]] (CD8+/CTL), temporal response of [[Tregs]], and the [[STAT3]] signaling pathway.  The role of the antitumor [[immune response]] in cancer therapeutics was explored historically through the use of [[bacteria]] to enhance the antitumor [[immune response]] and more recently  in cellular [[Immunotherapy]].<ref name="Transfusion and Apheresis Science" /> However, the impact of transfusion-related immunomodulation (TRIM) on cancer progression has not been definitively established and requires further study.<ref name="o019">{{cite journal | last1=Abou Daher | first1=Layal | last2=Heppell | first2=Olivia | last3=Lopez-Plaza | first3=Ileana | last4=Guerra-Londono | first4=Carlos E. | title=Perioperative Blood Transfusions and Cancer Progression: A Narrative Review | journal=Current Oncology Reports | volume=26 | issue=8 | date=2024 | issn=1534-6269 | pmid=38847973 | doi=10.1007/s11912-024-01552-3 | pages=880–9}}</ref>
*In retrospective studies, blood transfusion has been associated with worse outcomes after [[cytoreductive surgery]] and [[Hyperthermic intraperitoneal chemotherapy|HIPEC]].<ref>{{cite journal | vauthors = Soldevila-Verdeguer C, Segura-Sampedro JJ, Pineño-Flores C, Sanchís-Cortés P, González-Argente X, Morales-Soriano R | title = Hepatic resection and blood transfusion increase morbidity after cytoreductive surgery and HIPEC for colorectal carcinomatosis | journal = Clinical & Translational Oncology | volume = 22 | issue = 11 | pages = 2032–9 | date = November 2020 | pmid = 32277348 | doi = 10.1007/s12094-020-02346-2 | s2cid = 215724889 }}</ref> However, correlation does not prove causation, and transfused patients often have more complicated surgeries and more underlying cardiopulmonary disease compared to untransfused patients; conclusions should be based on prospective [[randomized controlled trial]]s.
* Hypothermia can occur with transfusions with large quantities of blood products which normally are stored at cold temperatures. Core body temperature can go down as low as 32&nbsp;°C and can produce physiologic disturbances. Prevention should be done with warming the blood to ambient temperature prior to transfusions.  Blood warming devices are available to avoid the hemolysis that would occur from unsafe practices such as microwaving.<ref name="g135">{{cite journal | last1=Poder | first1=Thomas G. | last2=Nonkani | first2=Wendyam G. | last3=Tsakeu Leponkouo | first3=Élyonore | title=Blood Warming and Hemolysis: A Systematic Review With Meta-Analysis | journal=Transfusion Medicine Reviews | volume=29 | issue=3 | date=2015 | issn=1532-9496 | pmid=25840802 | doi=10.1016/j.tmrv.2015.03.002 | pages=172–180}}</ref>
* Transfusions with large amounts of red blood cells, whether due to severe hemorrhaging and/or transfusion inefficacy (see above), can lead to an inclination for bleeding. The mechanism is thought to be due to disseminated intravascular coagulation, along with dilution of recipient platelets and coagulation factors. Close monitoring and transfusions with platelets and plasma is indicated when necessary.  Progressive hemorrhagic injury (PHI) in traumatic brain injured patients may be worsened by liberal transfusion strategies.<ref name="i975">{{cite journal | last1=Vedantam | first1=Aditya | last2=Yamal | first2=Jose-Miguel | last3=Rubin | first3=Maria Laura | last4=Robertson | first4=Claudia S. | last5=Gopinath | first5=Shankar P. | title=Progressive hemorrhagic injury after severe traumatic brain injury: effect of hemoglobin transfusion thresholds | journal=Journal of Neurosurgery | volume=125 | issue=5 | date=2016 | pmid=26943843 | pmc=5065393 | doi=10.3171/2015.11.JNS151515 | pages=1229–34}}</ref>
* Metabolic alkalosis can occur with massive blood transfusions because of the breakdown of citrate stored in blood into bicarbonate. However, acidemia is common in massively transfused patients, and acid-base balance is affected by complex factors.<ref name="j156">{{cite journal | last1=Schriner | first1=Jacob B. | last2=Van Gent | first2=J. Michael | last3=Meledeo | first3=M. Adam | last4=Olson | first4=Scott D. | last5=Cotton | first5=Bryan A. | last6=Cox | first6=Charles S. | last7=Gill | first7=Brijesh S. | title=Impact of Transfused Citrate on Pathophysiology in Massive Transfusion | journal=Critical Care Explorations | volume=5 | issue=6 | date=2023 | pmid=37275654 | pmc=10234463 | doi=10.1097/CCE.0000000000000925 | page=e0925}}</ref>
* Hypocalcemia can also occur with massive blood transfusions because of the complex of citrate with serum calcium. Calcium levels below 0.9&nbsp;mmol/L should be treated.<ref>{{cite web | vauthors = Sklar R |title=Damage Control Resuscitation and Management in Severe Hemorrage/Shock in the Prehospital Setting|url=https://internationaltraumalifesupport.remote-learner.net/pluginfile.php/8291/mod_resource/content/1/Position%20Paper%20-%20Damage%20Control%20Resuscitation%20-%202019.pdf |archive-url=https://ghostarchive.org/archive/20221009/https://internationaltraumalifesupport.remote-learner.net/pluginfile.php/8291/mod_resource/content/1/Position%20Paper%20-%20Damage%20Control%20Resuscitation%20-%202019.pdf |archive-date=2022-10-09 |url-status=live |website=internationaltraumalifesupport.remote-learner.net |publisher=ITLA |date=May 2019}}</ref>
* [[Blood doping]] has been used by athletes to increase physical stamina.<ref name="q308">{{cite journal | last1=Marchand | first1=Alexandre | last2=Roulland | first2=Ingrid | last3=Semence | first3=Florian | last4=Jaffredo | first4=Franck | last5=Dehainault | first5=Catherine | last6=Le Guiner | first6=Soizic | last7=Le Pajolec | first7=Marie-Gaëlle | last8=Donati | first8=Francesco | last9=Mekacher | first9=Lamine Redouane | last10=Lamek | first10=Kahina | last11=Ericsson | first11=Magnus | title=Evaluation of the detection of the homologous transfusion of a red blood cell concentrate in vivo for antidoping | journal=Drug Testing and Analysis | volume=15 | issue=11–12 | date=2023 | issn=1942-7611 | pmid=36709998 | doi=10.1002/dta.3448 | pages=1417–29| doi-access=free }}</ref> A lack of knowledge and insufficient experience can turn a blood transfusion into a dangerous event. For example, improper storage involving freezing and thawing, or minor antigen incompatibility, could lead to hemolysis.