E-Book 2nd Congress

  • Free mitochondrial DNA DAMPs in blood products associated with adverse transfusion reactions
  • Reihaneh Vahabzadeh,1 Saeede Bagheri,2 Mohammad Hossein Ahmadi,3,*
    1. Department of Laboratory Sciences, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
    2. Department of Laboratory Sciences, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
    3. Department of Laboratory Sciences, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.


  • Introduction: Mitochondria is mostly known as the center of energy production in the cells, as its main role is to produce ATP. Damage-associated molecular patterns (DAMPs) are endogenous danger molecules that are released from cells during cellular stress or tissue injury. Extracellular mitochondria and their various fragments, such as mitochondrial DNA (mtDNA), are considered DAMPs and can be released from blood products during blood collection, blood processing, and storage. MtDNA can stimulate the innate immune system and induce inflammation due to its similarities with bacterial double-stranded circular DNA. Several studies have demonstrated a potential role for extracellular mtDNA in adverse transfusion reactions. Therefore, mtDNA has become a critical issue in blood product transfusion. In this study, we aimed to investigate the relation between mtDNA presence in blood products and adverse transfusion reactions.
  • Methods: Electronic databases including: PUBMED and Google Scholar were searched with keywords such as free mitochondrial DNA AND transfusion, mitochondrial DAMPs, and mtDNA AND adverse transfusion reactions. Articles published between 2010 and 2023 were examined.
  • Results: Our review showed that the presence of mtDNA in platelet concentrates (PCs) is significantly associated with transfusion reactions such as febrile non-hemolytic transfusion reaction (FNHTR), and hypersensitivity transfusion reactions (HTRs). Fresh frozen plasma (FFP) and PCs's mtDNA levels are closely correlated to the occurrence of acute respiratory distress syndrome (ARDS) in recipients. In addition, extracellular mtDNA DAMPs present in transfusion products can act as a potential TRALI (transfusion‐related acute lung injury) agent. The transfer of blood products from the donor to the recipient and the presence of extracellular DNA including mtDNA in these products can lead to the transfer of genetic and epigenetic information from the donor to the recipient. Furthermore, the presence of DNA (including mtDNA) derived from the donor in recipient's body can be related to real or potential health implications in autoimmune diseases and graft-versus-host reactions (GVHR).
  • Conclusion: The presence of mtDNA in blood products is one of the principal challenges of blood transfusion, which is leading to complications in recipients. Hence, identifying the mechanisms of mtDNA release in blood products is a major step forward to reduce mtDNA, and further research is needed to investigate these mechanisms. Several methods can be used to reduce mtDNA in blood products, including reducing the storage time, using leukoreduction filters and adding addictive solutions to blood products, which by reducing mtDNA, subsequently reduce adverse transfusion reactions.
  • Keywords: Mitochondrial DNA, DAMPs, Blood products, Adverse transfusion reactions.