Macrophage prostaglandin E2 and oxidative responses to endotoxin during immunosuppression associated with anaesthesia and transfusion

The widespread use of blood transfusion in major surgical procedures has led to concern about the immunosuppressive effect of transfusion on patients with underlying malignancy. Transfusion may also suppress the host response to infection. The cellular mechanisms of transfusion-associated immunosuppression may involve macrophage prostaglandin E₂ (PGE₂) in modulating the host response to cancer and infection. We previously observed that the transfusion of blood increased PGE₂ production by unstimulated macrophages. To investigate this PGE₂ associated immunosuppression, we studied the effect of transfusion of rats using a physiological stimulus of macrophage PGE₂ production, bacterial endotoxin. In the same macrophages, we analysed intracellular oxidative activity. Both allogeneic and syngeneic blood transfusion were associated with increased PGE₂ release by macrophages. This stimulation of PGE₂ increased with duration of storage of blood. A similar effect of serum indicated that a humoral factor was involved. Endotoxin (50 ng/ml–500 μg/ml) stimulated PGE₂ production in all transfused subjects. The lowest endotoxin concentration gave proportionately the greatest stimulation. Oxidative activity was down-regulated in macrophages of transfused rats, supporting an immunosuppressive role of PGE₂ within the macrophage. An effect of surgery on the oxidative response was also detected.