The aged erythrocyte: key player in cancer progression, but also in infectious and respiratory complications of blood transfusion?

We read the study of Atzil et al. 1 on the deleterious effect of storage of erythrocytes on cancer progression in two tumor rat models. Using different transfusion products, the impact of erythrocytes, leukocytes, and leukocyte-derived soluble factors on host ability to clear circulating cancer cells and host survival rates was assessed. Blood transfusion was found to be an independent risk factor for cancer progression. Surprisingly, aged erythrocytes (9 days and older), rather than leukocytes or soluble factors, mediated the effects. The authors hypothesized that aged erythrocytes may preoccupy host-innate immune effector cells, leaving tumor cells unattended. Besides cancer progression, other adverse effects of blood transfusion may also be influenced by storage time of erythrocytes. Transfusion of nonleucoreduced aged erythrocytes was found to be associated with an increase in postoperative infectious complications. 2,3 To date, the mechanism of this phenomenon is not clear. A role for leukocytes and/or soluble factors in the stored blood products has been suggested.

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