Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc
Journal website https://jh.elmerpub.com

Review

Volume 14, Number 4, August 2025, pages 165-173

Beyond the Blood Cell: The Emerging Role of Cell-Free DNA in Transfusion Medicine

Figures

↓  Figure 1. Theorized effects of cfDNA on the transfusion recipient. The impact of transfused cfDNA on the recipient may vary widely depending on factors such as cfDNA concentration, the recipient’s genomic background and lifestyle, and the cellular origin of the cfDNA. It is hypothesized that cfDNA bound to histones may evade DNase degradation and potentially integrate into the host genome. This integration could influence gene regulation by promoting transcriptional activation or silencing. cfDNA has also been associated with genomic instability in theoretical models. If not effectively cleared by the immune system, donor cfDNA may contribute to enhanced immune activation, potentially triggering responses linked to transplant rejection or the activation of pathways involving tumor suppressor genes, oncogenes, or Toll-like receptors. cfDNA: cell-free DNA; CpG: cytosine-phosphate-guanine; TLR: Toll-like receptor.
Figure 1.
↓  Figure 2. Potential sources of donor-derived cfDNA in transfused blood. Donor blood may contain various sources of cfDNA, including DNA from white blood cells, stem cells, NETs, dietary DNA (e.g., from GMOs), nuclear DNA, and mt-cfDNA. These fragments can persist in the recipient’s circulation post-transfusion, despite leukoreduction, and may contribute to downstream immunologic or epigenetic effects. cfDNA: cell-free DNA; cfDNA-mt: mitochondrial cell-free DNA; GMOs: genetically modified organisms; NETs: neutrophil extracellular traps.
Figure 2.