OPEN ACCESS

©NIJBAS ONLINE ISSN: 2992-5797

Publications 2023 PRINT ISSN: 2992-6122

NEWPORT INTERNATIONAL JOURNAL OF BIOLOGICAL AND

APPLIED SCIENCES (NIJBAS)
Volume 3 Issue 3 2023
https://doi.org/10.59298/NIJBAS/2023/1.1.11000 Page | 1
Immunomodulatory Effects of Transfusions on
Maternal Immunity in Pregnancy
*Emmanuel Ifeanyi Obeagu1, Getrude Uzoma Obeagu2, Joseph Obiezu
Chukwujekwu Ezeonwumelu3, Frances Ugonne Ogunnaya4, Anthonia
Onyinye Ngwoke5 and Okechukwu Paul-Chima Ugwu6

1
Department of Medical Laboratory Science, Kampala International
University, Uganda.
2
School of Nursing Science, Kampala International University, Uganda.
3
Department of Clinical Pharmacy and Pharmacy Practice, School of
Pharmacy, Kampala International University, Western Campus, Ishaka,
Bushenyi, Uganda.
4
Department of Internal Medicine, Newark Beth Israel Medical Center,
201 Lyons Avenue, Newark NJ.
5
Department of Human Physiology, Faculty of Basic Medical Sciences,
Enugu State University of Science and Technology, Enugu State,
Nigeria.
6
Department of Publication and Extension, Kampala International
University, Uganda.
*
Corresponding author: Emmanuel Ifeanyi Obeagu, Department of
Medical Laboratory Science, Kampala International University,
Uganda.
E-mail: emmanuelobeagu@yahoo.com, obeagu.emmanuel@kiu.ac.ug,
ORCID: 0000-0002-4538-0161

ABSTRACT
Pregnancy represents a unique immunological state where maternal immune adaptations play a pivotal role in
supporting fetal development while maintaining tolerance to the semi-allogeneic fetus. Blood transfusions, often
necessary during pregnancy for various medical conditions, present an intriguing avenue for understanding
alterations in maternal immunity. This comprehensive review aims to elucidate the intricate immunomodulatory
effects of blood transfusions on maternal immunity during pregnancy. Beginning with an exploration of normal
immunological changes in pregnancy, this review navigates through the immunomodulatory challenges posed by
blood transfusions. The impact of donor factors, transfusion-related immunological components, and their influence

©Obeagu et al., 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
 OPEN ACCESS
©NIJBAS ONLINE ISSN: 2992-5797
Publications 2023 PRINT ISSN: 2992-6122
on the maternal immune system are scrutinized. Mechanistic insights into altered cytokine responses, adaptive
immune changes, and the role of regulatory T cells post-transfusion form critical focal points. Clinically, discerning
the implications of altered maternal immunity on fetal, neonatal health, and obstetric outcomes is essential.
Assessing risks and benefits associated with transfusions in pregnancy further underscores the clinical relevance of
understanding these immunomodulatory effects. Despite advancements, this review acknowledges research gaps
and limitations, highlighting the need for future investigations. Recommendations for prospective studies and
potential clinical implications conclude this review, emphasizing the significance of comprehending Page | 2
immunomodulation in maternal immunity post-transfusion for optimizing maternal-fetal health. In conclusion, this
review encapsulates current knowledge, challenges, and future directions in comprehending the complex interplay
between blood transfusions and maternal immune responses during pregnancy, offering valuable insights into a
crucial aspect of perinatal medicine.
Keywords: blood transfusions; maternal immunity; pregnancy; immunomodulation; cytokines; alloimmunization;
inflammation; transplacental immunomodulation

INTRODUCTION
Pregnancy, an intricate physiological state, orchestrates a delicate balance between maternal immune tolerance and
defense while nurturing the developing fetus [1]. Throughout gestation, a myriad of immunological adaptations
ensures a harmonious coexistence between the mother's immune system and the semi-allogeneic fetus [2-6].
However, this equilibrium can be perturbed by various factors, among which blood transfusions emerge as a
noteworthy entity triggering alterations in maternal immune responses [7]. The necessity for blood transfusions
during pregnancy arises in scenarios involving maternal medical complexities, such as severe anemia, hemorrhage,
or hemoglobinopathies, where maintaining maternal health becomes inseparable from safeguarding fetal well-being
[8-12]. Yet, the implications of these transfusions on the finely tuned maternal immune system remain an area of
burgeoning interest and concern. This paper seeks to delve into the multifaceted interactions between blood
transfusions and maternal immunity during pregnancy. We embark on this exploration by first illuminating the
normal immunological adaptations intrinsic to pregnancy. These adaptations are essential for sustaining fetal
development while simultaneously averting immune-mediated fetal rejection—an exquisite dance orchestrated by
the maternal immune system. Subsequently, we venture into the intricate realm where transfusions intersect with
maternal immunity [13]. Exploring the immunological components within transfused blood, the impact of donor-
related factors, and the subsequent modulation of maternal immune responses post-transfusion will form the core of
our investigation. Moreover, understanding the mechanistic underpinnings of these immunomodulatory effects
becomes imperative [14]. Alterations in cytokine profiles, shifts in adaptive immune responses, and the involvement
of regulatory T cells post-transfusion represent key aspects that demand elucidation.Amidst the scientific curiosity
lies the clinical imperative—deciphering the consequences of altered maternal immunity on fetal and neonatal health,
as well as obstetric outcomes [15]. An in-depth assessment of risks, benefits, and associated complications stemming
from blood transfusions during pregnancy will be intricately woven into our exploration [16-23]. While
considerable strides have been made in unraveling these complexities, gaps in understanding persist. Thus, this
review not only consolidates existing knowledge but also highlights the pressing need for further research endeavors
to fill these lacunae. This paper endeavors to navigate through the landscape where blood transfusions intersect
with the finely tuned maternal immune system during pregnancy. By synthesizing current insights, identifying
challenges, and delineating future directions, this exploration aims to contribute to the evolving dialogue in perinatal
medicine, aiming to optimize maternal and fetal health outcomes.
Immunological Changes in Pregnancy
Immunological changes during pregnancy are fundamental adaptations that support successful gestation,
contributing to maternal-fetal tolerance while maintaining the capacity to defend against pathogens [24]. These
alterations occur across various components of the immune system and are essential for both protecting the
developing fetus and facilitating maternal health. These hormones play pivotal roles in immune modulation during
pregnancy. They regulate immune cell function, cytokine production, and the balance between pro-inflammatory
and anti-inflammatory responses. Shifts in the adaptive immune response involve alterations in T cell subsets,
particularly an increase in regulatory T cells (Tregs) that promote immune tolerance to fetal antigens, preventing
immune-mediated rejection of the fetus [25]. The placenta serves as an immunological barrier, allowing selective
passage of nutrients and oxygen while protecting against pathogens [26]. Specialized immune cells at the maternal-
fetal interface, such as decidual natural killer (dNK) cells, play crucial roles in maintaining this delicate balance.
These cells undergo functional changes, ensuring a balanced response to pathogens without provoking excessive
inflammation, critical for protecting both the mother and the developing fetus Altered regulation of the complement
©Obeagu et al., 2023
This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
 OPEN ACCESS
©NIJBAS ONLINE ISSN: 2992-5797
Publications 2023 PRINT ISSN: 2992-6122
system aids in defending against infections while preventing excessive immune activation at the fetal-maternal
interface [27]. Pregnancy shifts the immune response towards Th2 dominance, favoring anti-inflammatory
responses and immune tolerance [28]. This shift is essential for preventing rejection of the semi-allogeneic fetus.
Increased production of cytokines like IL-10 and TGF-beta promotes immune tolerance and suppresses potentially
harmful immune responses against fetal antigens [29-37]. The maternal microbiome undergoes alterations,
influencing immune responses [38]. These changes are crucial for maternal health and can also impact fetal
development and the immune system's programming in the offspring. Understanding these immunological changes Page | 3
in pregnancy is vital for comprehending the delicate balance between immune tolerance and defense. These
adaptations not only protect the developing fetus but also contribute to maternal health throughout gestation.
Dysregulation of these mechanisms can lead to pregnancy complications and adverse outcomes, underscoring the
importance of elucidating the complex interplay of the maternal immune system during pregnancy.
Blood Transfusion and Immunomodulation
Blood transfusion involves the transfer of blood or blood components from a donor to a recipient, often used in
various medical scenarios to restore blood volume, improve oxygen-carrying capacity, or manage specific conditions
[39-43]. Leukocyte-containing blood products can introduce donor immune cells to the recipient, potentially
impacting immune responses [44]. Blood products may contain various immunomodulatory molecules that can
influence recipient immune cells upon transfusion. Disparities between donor and recipient HLA antigens can
trigger immune responses, potentially leading to alloimmunization or immune reactions [45]. Transfused blood can
carry pathogens, prompting immune reactions or infections in recipients. Transfusion-related inflammatory
reactions may occur, leading to cytokine release and activation of recipient immune cells [46]. In certain scenarios,
transfusions might exert immunosuppressive effects, impacting the recipient's ability to mount an effective immune
response. Exposure to foreign antigens through transfusions can induce alloimmunization, leading to the production
of antibodies against donor antigens [47]. Incompatibility reactions may occur if the recipient's immune system
reacts against antigens present in the transfused blood, resulting in acute or delayed immune-mediated responses.
The concept of Transfusion-Associated Immunomodulation (TRIM) refers to alterations in recipient immune
function post-transfusion, which may impact clinical outcomes, infection susceptibility, and long-term immune
health. Immunocompromised individuals, such as pregnant women, neonates, or those with existing immune-related
conditions, may experience unique immunomodulatory effects following transfusions [48]. Understanding the
immunomodulatory effects of blood transfusions is crucial for optimizing transfusion strategies, managing potential
complications, and ensuring the safety and efficacy of transfusion therapies. Further research is necessary to
delineate the precise mechanisms underlying these effects and their implications, especially in vulnerable populations
like pregnant women, where the balance between immunomodulation and maintaining maternal-fetal health is of
paramount importance.
Mechanisms of Immunomodulation
The mechanisms of immunomodulation following blood transfusions involve complex interactions between
components within the transfused blood and the recipient's immune system [49]. Disparities between donor and
recipient HLA antigens can lead to antigen presentation by recipient antigen-presenting cells (APCs), triggering
immune responses against donor antigens [50]. Minor mismatches in histocompatibility antigens can also stimulate
immune recognition and subsequent responses. Transfusions can introduce cytokines and chemokines present in the
blood product, influencing recipient immune cells and inducing inflammatory or immunomodulatory responses
[51]. Various soluble factors present in the transfused blood, such as prostaglandins, soluble HLA molecules, or
immunoglobulins, can modulate recipient immune cell function [52]. If present in the transfused blood, donor
leukocytes can interact with recipient immune cells, potentially triggering immune reactions or influencing immune
cell function. Components in the transfused blood can activate toll-like receptors (TLRs) in recipient immune cells,
initiating innate immune responses [53]. Transfusions may induce regulatory immune responses, promoting
immune tolerance to donor antigens and modulating recipient immune cell activity [54]. In certain cases,
transfusions might exert immunosuppressive effects, dampening recipient immune responses and affecting the
ability to mount an appropriate defense against pathogens. Immunomodulation post-transfusion in pregnant women
can impact maternal immune responses, potentially affecting fetal health and pregnancy outcomes [55]. Individuals
with compromised immune systems might exhibit altered immunomodulatory effects, impacting their susceptibility
to infections or potential complications post-transfusion. Transfusion-related inflammatory reactions can activate
recipient immune cells, leading to cytokine release and systemic inflammatory responses [56]. Subsequent
transfusions or re-exposure to specific antigens might trigger memory immune responses, impacting the intensity
or nature of subsequent immune reactions. Elucidating these mechanisms is critical for understanding the
multifaceted immunomodulatory effects of transfusions, determining their clinical implications, and optimizing

©Obeagu et al., 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
 OPEN ACCESS
©NIJBAS ONLINE ISSN: 2992-5797
Publications 2023 PRINT ISSN: 2992-6122
transfusion practices, especially in vulnerable populations or those requiring frequent transfusions. Continued
research is essential to unravel the complexities of these mechanisms and their impact on recipient immune function.
Clinical Implications and Outcomes
The immunomodulatory effects of blood transfusions have several clinical implications and potential outcomes,
influencing various aspects of recipient health and treatment [57]. Understanding these implications is crucial for
optimizing transfusion practices and ensuring patient safety. Altered immune responses post-transfusion might
affect the recipient's ability to fight infections, potentially increasing susceptibility to certain pathogens. Blood Page | 4
transfusions may induce immunomodulatory changes in recipients, impacting immune function and potentially
affecting long-term immune health [58]. Immunological reactions against transfused antigens can lead to acute
transfusion reactions, presenting as fever, hemolysis, or allergic responses. Some recipients may develop delayed
immune-mediated complications such as transfusion-related alloimmunization or delayed hemolytic reactions.
Exposure to foreign antigens in transfused blood can stimulate the recipient's immune system to produce antibodies
against donor antigens, leading to alloimmunization [59]. Alloimmunization can result in complications during
subsequent transfusions, organ transplantation, or pregnancies. Immunomodulation in pregnant women following
transfusions might influence maternal immune responses, potentially affecting fetal health and pregnancy outcomes
[60]. Development of antibodies due to transfusions can lead to alloimmune reactions in subsequent pregnancies,
causing complications such as hemolytic disease of the fetus and newborn. Understanding the immunomodulatory
effects of transfusions aids in evaluating the risks and benefits associated with transfusion therapy, especially in
vulnerable populations. Awareness of potential immunological complications encourages exploring alternative
therapies or strategies to reduce transfusion-related risks. Identifying and understanding the precise mechanisms
underlying immunomodulation post-transfusion is crucial for improving transfusion safety and efficacy. Insights
into immunomodulatory effects may inform the development of guidelines and protocols aimed at minimizing
adverse outcomes and optimizing patient care. Acknowledging these clinical implications underscores the
importance of ongoing research and vigilant monitoring in transfusion medicine. By comprehending the
immunomodulatory effects and their potential impact on recipient health, healthcare practitioners can make
informed decisions, mitigate risks, and optimize transfusion strategies for improved patient outcomes.
Research Challenges and Future Directions
Addressing the immunomodulatory effects of blood transfusions presents several research challenges and prompts
the exploration of future directions to enhance our understanding and improve clinical outcomes [61].
Understanding the intricate mechanisms by which transfusions modulate recipient immune responses remains a
challenge, necessitating detailed studies to dissect these interactions at a molecular and cellular level. Investigating
why certain recipients exhibit varied immunomodulatory responses post-transfusion compared to others,
considering factors such as patient characteristics and transfusion specifics. Accounting for the diversity in patient
populations, including pregnant women, neonates, immunocompromised individuals, and those with underlying
conditions, to comprehend how immunomodulation differs among these groups. Exploring the long-term
consequences of transfusion-associated immunomodulation on patient immune health, including risks of infections,
autoimmune conditions, or altered responses to subsequent therapies. Developing strategies to minimize adverse
immunological reactions, alloimmunization, and immune-related complications associated with transfusions,
ensuring safer transfusion practices [62]. Investigating alternative transfusion approaches or adjunct therapies that
mitigate immunomodulatory effects while maintaining efficacy in treating conditions requiring transfusions.
Translating research insights into clinical guidelines or protocols to aid healthcare practitioners in optimizing
transfusion strategies based on the evolving understanding of immunomodulation. Establishing standardized
approaches or protocols for assessing immunomodulatory effects post-transfusion, facilitating consistent evaluation
across different clinical settings. Employing advanced experimental models, including in vitro assays, animal models,
and sophisticated computational approaches, to simulate and study immunomodulatory effects in a controlled
environment [63]. Leveraging omics technologies (genomics, transcriptomics, proteomics) to comprehensively
analyze immune responses pre- and post-transfusion, providing a deeper understanding of molecular alterations.
Addressing ethical considerations regarding informed consent, risk communication, and patient autonomy in the
context of transfusion-related research involving vulnerable populations. Conducting studies that prioritize patient
outcomes, preferences, and safety to shape transfusion strategies that align with patient needs and values.
Addressing these research challenges and advancing these future directions holds promise for unraveling the
complexities of transfusion-induced immunomodulation. Through interdisciplinary collaborations and innovative
approaches, researchers can pave the way for safer transfusion practices and improved clinical management while
considering the diverse needs of patients receiving transfusions.

©Obeagu et al., 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
 OPEN ACCESS
©NIJBAS ONLINE ISSN: 2992-5797
Publications 2023 PRINT ISSN: 2992-6122
CONCLUSION
In conclusion, the immunomodulatory effects of blood transfusions during pregnancy and in diverse patient
populations represent a multifaceted area of study with significant clinical implications. Throughout this
exploration, it becomes evident that comprehending the complexities of transfusion-induced immunomodulation is
crucial for optimizing patient care, particularly in vulnerable cohorts like pregnant women and immunocompromised
individuals. The intricate interplay between transfused blood components and recipient immune systems presents
both opportunities and challenges. While blood transfusions serve as life-saving interventions, their potential to Page | 5
modulate immune responses necessitates a thorough understanding of the mechanisms underlying these effects. In
moving forward, interdisciplinary collaboration, innovative methodologies, and a patient-centered approach will be
instrumental in addressing these challenges and advancing our understanding of transfusion-induced
immunomodulation. This knowledge will not only refine transfusion practices but also guide the development of
tailored interventions, ultimately enhancing the safety and efficacy of transfusion therapies while prioritizing the
well-being of diverse patient populations.
REFERENCES
1. Espino, A., El Costa, H., Tabiasco, J., Al-Daccak, R., & Jabrane-Ferrat, N. (2021). Innate immune response
to viral infections at the maternal-fetal interface in human pregnancy. Frontiers in Medicine, 8, 674645.
2. Yoshizawa, R. S. (2014). Placentations: Agential realism and the science of afterbirths (Doctoral dissertation,
Queen's University).
3. Obeagu, E. I., Obeagu, G. U., & Ogunnaya, F. U. (2023). Deep vein thrombosis in pregnancy: A review of
prevalence and risk factors. Int. J. Curr. Res. Chem. Pharm. Sci, 10(8), 14-21.
4. Obeagu, E. I., & Obeagu, G. U. (2023). Molar Pregnancy: Update of prevalence and risk factors. Int. J. Curr.
Res. Med. Sci, 9(7), 25-8.
5. Obeagu, E. I., Obeagu, G. U., & Adepoju, O. J. (2022). Evaluation of haematological parameters of pregnant
women based on age groups in Olorunsogo road area of Ido, Ondo state. J. Bio. Innov11 (3), 936-941.
6. Obeagu, E. I., Adepoju, O. J., Okafor, C. J., Obeagu, G. U., Ibekwe, A. M., Okpala, P. U., & Agu, C. C. (2021).
Assessment of Haematological Changes in Pregnant Women of Ido, Ondo State, Nigeria. J Res Med Dent
Sci, 9(4), 145-8.
7. Villa, C. H., Anselmo, A. C., Mitragotri, S., & Muzykantov, V. (2016). Red blood cells: Supercarriers for
drugs, biologicals, and nanoparticles and inspiration for advanced delivery systems. Advanced drug delivery
reviews, 106, 88-103.
8. Ross, P. T. (2013). Risking reproduction reproductive health among women with sickle cell disease. Wayne State
University.
9. Obeagu, E. I., Ezimah, A. C., & Obeagu, G. U. (2016). Erythropoietin in the anaemias of pregnancy: a review.
Int J Curr Res Chem Pharm Sci, 3(3), 10-8.
10. Obeagu, E. I., & Agreen, F. C. (2023). Anaemia among pregnant women: A review of African pregnant
teenagers. J Pub Health Nutri. 2023; 6 (1), 138.
11. Obeagu, E. I., & Ogunnaya, F. U. (2023). Pregnancyinduced Haematological Changes: A Key To Marternal
And Child Health. European Journal of Biomedical, 10(8), 42-3.
12. Obeagu, E. I., Hassan, A. O., Adepoju, O. J., Obeagu, G. U., & Okafor, C. J. (2021). Evaluation of Changes
in Haematological Parameters of Pregnant Women Based on Gestational Age at Olorunsogo Road Area of
Ido, Ondo State. Nigeria. Journal of Research in Medical and Dental Science, 9(12), 462-4.
13. Kelly, S. E. (2012). The maternal–foetal interface and gestational chimerism: the emerging importance of
chimeric bodies. Science as Culture, 21(2), 233-257.
14. Sharma, S., Banerjee, S., Krueger, P. M., & Blois, S. M. (2022). Immunobiology of gestational diabetes
mellitus in post-medawar era. Frontiers in Immunology, 12, 758267.
15. Osborne, C., Kolakowski, M., & Lobenstine, D. (2021). Pre-And Perinatal Massage Therapy: A Comprehensive
Guide to Prenatal, Labor and Postpartum Practice. Jessica Kingsley Publishers.
16. Gamde, M. S., & Obeagu, E. I. (2023). Iron Deficiency Anaemia: Enemical to Pregnancy. European Journal
of Biomedical, 10(9), 272-275.
17. Obeagu EI, Hassan AO, Adepoju OJ, Obeagu GU, Okafor CJ. Evaluation of Changes in Haematological
Parameters of Pregnant Women Based on Gestational Age at Olorunsogo Road Area of Ido, Ondo State.
Nigeria. Journal of Research in Medical and Dental Science. 2021;9(12):462-.
18. Obeagu, E. I., Ikpenwa, J. N., Chukwueze, C. M., & Obeagu, G. U. (2022). Evaluation of protein C, protein
S and fibrinogen of pregnant women in Owerri Metropolis. Madonna University Journal of Medicine and
Health Sciences ISSN: 2814-3035, 2(1), 292-298.

©Obeagu et al., 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
 OPEN ACCESS
©NIJBAS ONLINE ISSN: 2992-5797
Publications 2023 PRINT ISSN: 2992-6122
19. Obeagu, E. I. (2021). Comparative Study of Serum Iron and Hemoglobin Levels of Cord Blood of Normal
Neonates and that of Maternal Blood in Federal Medical Centre Owerri. Journal of Clinical and Laboratory
Research, 4(1), 2768-0487.
20. Anyiam, A. F., Obeagu, E. I., Obi, E., Omosigho, P. O., Irondi, E. A., Arinze-Anyiam, O. C., & Asiyah, M.
K. (2022). ABO blood groups and gestational diabetes among pregnant women attending University of
Ilorin Teaching Hospital, Kwara State, Nigeria. International Journal of Research and Reports in Hematology,
5(2), 113-121. Page | 6
21. Obeagu, E. I. (2023). Gestational Thrombocytopaenia. J Gynecol Women’s Health, 25(3), 556163.
22. Jakheng, S. P. E., & Obeagu, E. I. (2022). Seroprevalence of human immunodeficiency virus based on
demographic and risk factors among pregnant women attending clinics in Zaria Metropolis, Nigeria. J Pub
Health Nutri. 2022; 5 (8), 137.
23. Obeagu, E. I., Gamade, S. M., & Obeagu, G. U. (2023). The roles of Neutrophils in pregnancy. Int. J. Curr.
Res. Med. Sci, 9(5), 31-35.
24. Orefice, R. (2021). Immunology and the immunological response in pregnancy. Best practice & research
Clinical obstetrics & gynaecology, 76, 3-12.
25. Robertson, S. A., Care, A. S., & Moldenhauer, L. M. (2018). Regulatory T cells in embryo implantation and
the immune response to pregnancy. The Journal of clinical investigation, 128(10), 4224-4235.
26. Burton, G. J., Fowden, A. L., & Thornburg, K. L. (2016). Placental origins of chronic disease. Physiological
reviews, 96(4), 1509-1565.
27. Chighizola, C. B., Lonati, P. A., Trespidi, L., Meroni, P. L., & Tedesco, F. (2020). The complement system
in the pathophysiology of pregnancy and in systemic autoimmune rheumatic diseases during pregnancy.
Frontiers in immunology, 11, 2084.
28. Robinson, D. P., & Klein, S. L. (2012). Pregnancy and pregnancy-associated hormones alter immune
responses and disease pathogenesis. Hormones and behavior, 62(3), 263-271.
29. Okorie, H. M., Obeagu, E. I., Obarezi, H. C., & Anyiam, A. F. (2019). Assessment of some inflammatory
cytokines in malaria infected pregnant women in Imo State Nigeria. International Journal of Medical Science
and Dental Research, 2(1), 25-36.
30. Emeka-Obi, O. R., Ibeh, N. C., Obeagu, E. I., & Okorie, H. M. (2021). Evaluation of levels of some
inflammatory cytokines in preeclamptic women in owerri. Journal of Pharmaceutical Research International,
33(42A), 53-65.
31. Ifeanyi, O. E., Vincent, C. C. N., & Ugochi, C. M. J. (2019). Studies on some cytokines of apparently healthy
Nigerian women aged 10-40 years. Int. J. Curr. Res. Med. Sci, 5(12), 24-30.
32. Obeagu, E. I., Okoroiwu, I. L., & Obeagu, G. U. (2022). Relationship between Thrombopoietin and
Interleukin 3: A Review. Int J Curr Res Chem Pharm. Sci, 9(1), 7-13.
33. Obeagu, E. I., Muhimbura, E., Kagenderezo, B. P., Nakyeyune, S., & Obeagu, G. U. (2022). An Insight of
Interleukin-6 and Fibrinogen: In Regulating the Immune System. J Biomed Sci, 11(10), 83.
34. Ifeanyi, O., Uzoma, O., Amaeze, A., Ijego, A., Felix, C., Ngozi, A., ... & Chinenye, K. (2020). Maternal
expressions (serum levels) of alpha tumour necrosis factor, interleukin 10, interleukin 6 and interleukin 4
in malaria infected pregnant women based on parity in a Tertiary Hospital in Southeast, Nigeria. Journal of
Pharmaceutical Research International, 32(23), 35-41.
35. Obeagu, E., Felix, C. E., MTB, O., Chikodili, U. M., Nchekwubedi, C. S., & Chinedum, O. K. (2021). Studies
on some cytokines, CD4, iron status, hepcidin and some haematological parameters in pulmonary
tuberculosis patients based on duration of treatment in Southeast, Nigeria. African Journal of Biological
Sciences, 3(1), 146-156.
36. Obeagu, E. I., Amedu, G. O., Okoroiwu, I. L., Okafor, C. J., Okun, O., Ochiabuto, O. M., & Ukeekwe, C. O.
(2021). Evaluation of plasma levels of interleukin 6 and iron status of football players in a Nigerian
university. Journal of Pharmaceutical Research International, 33(59B), 383-388.
37. Obeagu, E. I., Obeagu, G. U., Guevara, M. E. C., Okafor, C. J., Bot, Y. S., Eze, G. C., ... & Uwakwe, O. S.
(2022). Evaluation of Plasma Levels of Interleukin 6 and Iron of Volleyball Players Based on Heights and
Weight of a Nigerian University Students. Asian Journal of Medicine and Health, 20(10), 147-152.
38. Macpherson, A. J., de Agüero, M. G., & Ganal-Vonarburg, S. C. (2017). How nutrition and the maternal
microbiota shape the neonatal immune system. Nature Reviews Immunology, 17(8), 508-517.
39. García-Roa, M., del Carmen Vicente-Ayuso, M., Bobes, A. M., Pedraza, A. C., González-Fernández, A.,
Martín, M. P., ... & Gutiérrez, L. (2017). Red blood cell storage time and transfusion: current practice,
concerns and future perspectives. Blood Transfusion, 15(3), 222.
©Obeagu et al., 2023
This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
 OPEN ACCESS
©NIJBAS ONLINE ISSN: 2992-5797
Publications 2023 PRINT ISSN: 2992-6122
40. Obeagu, E.I., Babar, Q. & Obeagu, G.U. (2021). Allergic blood Transfusion reaction: A Review. Int. J. Curr.
Res. Med. Sci. 7(5):25-33.
41. Obeagu, E.I., Oshim, I.O., Ochei, K.C. & Obeagu, G.U. (2016). Iron and blood donation: A Review. Int. J.
Curr. Res. Med. Sci. 2(10):16-48.
42. Okoroiwu, I.L., Obeagu, E.I., Elemchukwu, Q., Ochei, K.C. & Christian, G.S. (20150. Frequency of
Transfusion Reactions Following Compatible Cross Matching of Blood: A Study in Owerri Metropolis.
International Journal of Current Research and Academic Review. 3(1):155-60. Page | 7
43. Ogar, C.O., Okoroiwu, H.U., Obeagu, E.I., Etura, J.E. & Abunimye DA. (2021). Assessment of blood supply
and usage pre-and during COVID-19 pandemic: a lesson from non-voluntary donation. Transfusion
Clinique et Biologique. 28(1):68-72.
44. Brand, A. (2016). Immunological complications of blood transfusions. La Presse Médicale, 45(7-8), e313-
e324.
45. Montgomery, R. A., Tatapudi, V. S., Leffell, M. S., & Zachary, A. A. (2018). HLA in transplantation. Nature
reviews nephrology, 14(9), 558-570.
46. Neal, M. D., Raval, J. S., Triulzi, D. J., & Simmons, R. L. (2013). Innate immune activation after transfusion
of stored red blood cells. Transfusion medicine reviews, 27(2), 113-118.
47. Tormey, C. A., & Hendrickson, J. E. (2019). Transfusion-related red blood cell alloantibodies: induction and
consequences. Blood, The Journal of the American Society of Hematology, 133(17), 1821-1830.
48. Johnsen, J. (2012). Pathogenesis in immune thrombocytopenia: new insights. Hematology 2010, the American
Society of Hematology Education Program Book, 2012(1), 306-312.
49. Remy, K. E., Hall, M. W., Cholette, J., Juffermans, N. P., Nicol, K., Doctor, A. ... & Pediatric Critical Care
Blood Research Network (Blood Net). (2018). Mechanisms of red blood cell transfusion‐related
immunomodulation. Transfusion, 58(3), 804-815.
50. Alegre, M. L., Lakkis, F. G. & Morelli, A. E. (2016). Antigen presentation in transplantation. Trends in
immunology, 37(12), 831-843.
51. Davenport, R. D. (2009). An introduction to chemokines and their roles in transfusion medicine. Vox
sanguinis, 96(3), 183-198.
52. Brown, C. J., & Navarrete, C. V. (2011). Clinical relevance of the HLA system in blood transfusion. Vox
sanguinis, 101(2), 93-105.
53. Leventhal, J. S. & Schröppel, B. (2012). Toll-like receptors in transplantation: sensing and reacting to injury.
Kidney international, 81(9), 826-832.
54. Hendrickson, J. E. & Tormey, C. A. (2016). Understanding red blood cell alloimmunization triggers.
Hematology 2014, the American Society of Hematology Education Program Book, 2016(1), 446-451.
55. Sarkesh, A., Sorkhabi, A. D., Ahmadi, H., Abdolmohammadi-Vahid, S., Parhizkar, F., Yousefi, M. &
Aghebati-Maleki, L. (2022). Allogeneic lymphocytes immunotherapy in female infertility: lessons learned
and the road ahead. Life Sciences, 299, 120503.
56. Aguilar-Nascimento, J. E., Zampieri-Filho, J. P. & Bordin, J. O. (2021). Implications of perioperative
allogeneic red blood cell transfusion on the immune-inflammatory response. Hematology, Transfusion and
Cell Therapy, 43, 58-64.
57. Refaai, M. A. & Blumberg, N. (2013). Transfusion immunomodulation from a clinical perspective: an update.
Expert review of hematology, 6(6), 653-663.
58. Vamvakas, E. C. & Blajchman, M. A. (2001). Deleterious clinical effects of transfusion-associated
immunomodulation: fact or fiction? Blood, The Journal of the American Society of Hematology, 97(5), 1180-
1195.
59. Tormey, C. A. & Hendrickson, J. E. (2019). Transfusion-related red blood cell alloantibodies: induction and
consequences. Blood, The Journal of the American Society of Hematology, 133(17), 1821-1830.
60. Gonzalez, C. A. & Gonzalez, S. (2020). Fetal and neonatal allo-immune response. Transfusion and Apheresis
Science, 59(5), 102945.
61. Brown, J. B., Neal, M. D., Guyette, F. X., Peitzman, A. B., Billiar, T. R., Zuckerbraun, B. S. & Sperry, J. L.
(2015). Design of the study of tranexamic acid during air medical prehospital transport (STAAMP) trial:
addressing the knowledge gaps. Prehospital Emergency Care, 19(1), 79-86.
62. Yusoff, S. M., Bahar, R., Hassan, M. N., Noor, N. H. M., Ramli, M. & Shafii, N. F. (2020). Prevalence of red
blood cell alloimmunization among transfused chronic kidney disease patients in hospital Universiti Sains
Malaysia. Oman medical journal, 35(5), e177.

©Obeagu et al., 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
 OPEN ACCESS
©NIJBAS ONLINE ISSN: 2992-5797
Publications 2023 PRINT ISSN: 2992-6122
63. Day, J. D., Cockrell, C., Namas, R., Zamora, R., An, G. & Vodovotz, Y. (2018). Inflammation and disease:
modelling and modulation of the inflammatory response to alleviate critical illness. Current opinion in systems
biology, 12, 22-29.

CITE AS: Emmanuel Ifeanyi Obeagu, Getrude Uzoma Obeagu, Joseph Obiezu Chukwujekwu Ezeonwumelu,
Frances Ugonne Ogunnaya, Anthonia Onyinye Ngwoke and Okechukwu Paul-Chima Ugwu (2023). Page | 8
Immunomodulatory Effects of Transfusions on Maternal Immunity in Pregnancy. NEWPORT
INTERNATIONAL JOURNAL OF BIOLOGICAL AND APPLIED SCIENCES (NIJBAS) 3(3):1-8.
https://doi.org/10.59298/NIJBAS/2023/1.1.11000

©Obeagu et al., 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.