A Composite Immuno-inflammatory and Oxidative Stress Biomarker Panel for Risk Stratification in Multiple Blood-transfused Patients: A Systematic Review

Abstract

Background: Chronic blood transfusions in individuals with transfusion-dependent disorders such as thalassemia major and sickle cell disease (SCD) cause chronic inflammation, alloimmunization, and oxidative stress, which cumulatively impart damage to tissue and organs. The current systematic review will analyse the effectiveness of a novel panel of markers combining immuno-inflammatory and oxidative stress for better risk assessment in multi-transfused individuals. Methods: A search of PubMed and Scopus journals for literature published between the years 2010 and 2024 regarding oxidative and inflammatory biomarkers in chronically transfused patients was conducted. There was a focus on studies that developed models using multiple biomarkers. A conceptual composite biomarker risk stratification model based on normalized z-score integration of inflammatory, oxidative stress, and antioxidant markers was synthesized from the included studies. Results: Available evidence confirms that simultaneous assessment of inflammation (CRP, IL-6, TNF-α), oxidative stress (MDA, SOD, catalase), and immune responses (concentrations of alloantibodies, neopterin) improves clinical risk prediction over the assessment of any single factor. Ferritin, TNF-α, CRP or hs-CRP, and oxidative stress, with organ dysfunction, strongly predicted an elevated level of all variables (p<0.05). Research studies carried out in cardiovascular medicine and transfusion medicine confirmed that the total index values forecasted death rates, treatment success. Conclusion: A panel of immuno-inflammatory and oxidative stress biomarkers has a mechanistic and predictive role in the personal management of a variety of blood-transfused patients. The inclusion of these panels in the clinical management of the condition may be of benefit in the early diagnosis of oxidative inflammation.