Effect of Blood Donor Characteristics on Transfusion Outcomes: A Systematic Review and Meta-Analysis

Abstract

Optimal selection of blood donors is critical for ensuring the safety of blood products. The current selection process is concerned principally with the safety of the blood donor at the time of donation and of the recipient at the time of transfusion. Recent evidence suggests that the characteristics of the donor may affect short- and long-term transfusion outcomes for the transfused recipient. We conducted a systematic review with the primary objective of assessing the association between blood donor characteristics and red blood cell (RBC) transfusion outcomes. We searched MEDLINE, EMBASE, and Cochrane Central databases and performed manual searches of top transfusion journals for all available prospective and retrospective studies. We described study characteristics, methodological quality, and risk of bias and provided study-level effect estimates and, when appropriate, pooled estimates with 95% confidence intervals using the Mantel-Haenszel or inverse variance approach. The overall quality of the evidence was graded using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. From 6121 citations identified by our literature search, 59 studies met our eligibility criteria (50 observational, 9 interventional). We identified the evaluation of association of 17 donor characteristics on RBC transfusion outcome. The risk of bias and confounding of the included studies was high. The quality of evidence was graded as very low to low for all 17 donor characteristics. Potential associations were observed for donor sex with reduced survival at 90 days and 6 months in male recipients that receive donated blood from females (hazard ratio 2.60 [1.09, 6.20] and hazard ratio 2.40 [1.10, 5.24], respectively; n = 1), Human Leukocyte Antigen - antigen D Related (HLA-DR) selected transfusions (odds ratio [OR] 0.39 [0.15, 0.99] for the risk of transplant alloimmunization, n = 9), presence of antileukocyte antibodies (OR 5.84 [1.66, 20.59] for risk of transfusion-related acute lung injury, n = 4), and donor RBC antigens selection (OR 0.20 [0.08, 0.52] for risk of alloimmunization, n = 4). Based on poor quality evidence, positive antileukocyte antibodies, female donor to male recipients, HLA-DR selected RBC transfusion, or donor RBC antigen selection may affect RBC transfusion outcome. Our findings that donor characteristics may be associated with transfusion outcomes warrant establishing vein-to-vein data infrastructure to allow for large robust evaluations. PROSPERO registration number: CRD42013006726.

Frequent blood donations alter susceptibility of red blood cells to storage‐ and stress‐induced hemolysis

“…37–40 With regards to frequent blood donations, a recent study has demonstrated that RBCs produced by mice with mild iron deficiency have greatly decreased survival following storage and transfusion. 16 Several prospective and ongoing studies by this group and others are in progress to investigate the impact of donor characteristics (sex, donation history, iron repletion therapy) on autologous RBC recovery and survival and patient outcomes following allogeneic RBC transfusions.…”

“…In the absence of rigorous clinical studies that would evaluate transfusion outcomes, our current understanding of possible patient outcomes is limited to animal studies [34][35][36] or to retrospective studies that linked donor characteristics with the risk of transfusion-related mortality. [37][38][39][40] With regard to frequent blood donations, a recent study demonstrated that RBCs produced by mice with mild iron deficiency have greatly decreased survival following storage and transfusion. 16 Several prospective and ongoing studies by this group and others are in progress to investigate the impact of donor characteristics (sex, donation history, iron repletion therapy) on autologous RBC recovery and survival and patient outcomes following allogeneic RBC transfusions.…”

Transfusion as an Inflammation Hit: Knowns and Unknowns

“…First, a large Canadian clinical trial recently reported that age and sex of donors influenced the outcome of transfusion in recipients, more than any other factor (e.g., age of blood or pathology) (39, 40). Although there is now good evidence that there are differences between males and females in pathology and in particular in immune responses to infection or vaccines and inflammation processes, the gender issue has not been specifically addressed satisfactorily in transfusion medicine (41): this is perhaps a path for further investigation.…”

Research Opportunities to Improve Neonatal Red Blood Cell Transfusion

“…Thus, a similar approach in neonates and children is needed to better inform the extent and safety of, and approaches to RBC transfusion. In addition, understanding variation in donor characteristics is necessary to fully assess the effect of “vein-to-vein” variability in RBC donor characteristics on recipient outcomes [8]. Small, single center, narrowly focused studies have not, and cannot, provide sufficient data to guide neonatal RBC transfusion.…”