Background: Allogeneic packed red blood cell (PRBC) transfusion is commonly used in orthopedic surgery, but its role in transfusion-related immunomodulation (TRIM) remains unclear. We aimed to evaluate the effects of allogeneic PRBC transfusion on serum levels of interleukin-1 (IL-1) and interleukin-10 (IL-10) in patients undergoing primary total hip arthroplasty.
Methods: In this prospective comparative study, we enrolled 70 patients undergoing primary total hip arthroplasty. They were divided into two groups of 35 matched for gender and age, including the transfusion group (received allogeneic PRBCs stored for approximately 20 days) and the control group. Serum IL-1 and IL-10 levels were measured in triplicate using the enzyme-linked immunosorbent assay (ELISA) method at three time points: Baseline, day 1 after surgery, and day 7 after surgery. Data were analyzed using repeated-measures ANOVA and Pearson’s correlation test.
Results: Baseline IL-1 and IL-10 levels were similar between groups (P>0.05). Post-operatively, the control group showed a significant elevation in IL-1, reaching 273±28 pg/mL on day 7 compared to baseline (P<0.001). In the transfused group, IL-1 declined to 141±16 pg/mL by day 7, significant compared to day 1 (P<0.05), whereas IL-10 showed a 3.8-fold increase to 93±9 pg/mL (P<0.001). On day 7, a significant negative correlation between IL-1 and IL-10 was observed in the transfused group (r=−0.64, P<0.01), and the IL-10/IL-1 ratio was significantly higher in this group than in controls (0.66 vs 0.18, P<0.001).
Conclusion: The findings suggest that allogeneic PRBC transfusion is associated with a shift from a pro-inflammatory to anti-inflammatory post-operative cytokine pattern, supporting the TRIM concept and a cautious perioperative transfusion strategy.