Biological mechanisms implicated in adverse outcomes of sex mismatched transfusions

Alshalani, Abdulrahman; Li, Wenhui; Juffermans, Nicole P.; Seghatchian, Jerard; Acker, Jason P.

doi:10.1016/j.transci.2019.04.023

Cited by 13 publications

(20 citation statements)

References 74 publications

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“…Other studies have discussed the impact of donor age and sex on both the quality characteristics of RCCs during in vitro storage 22,25,28,65 and the transfusion efficacy, 66–69 with an increased risk of mortality due to sex‐mismatched transfusions 70–74 . fRBCs stored in vitro have generally shown superior quality measures, such as less susceptibility to storage‐induced hemolysis and mechanical fragility, and better rheologic properties compared to mRBCs 22,75 that can be related to a larger proportion of biologically younger RBCs in female donors 22,76 .…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have discussed the impact of donor age and sex on both the quality characteristics of RCCs during in vitro storage 22,25,28,65 and the transfusion efficacy, [66][67][68][69] with an increased risk of mortality due to sex-mismatched transfusions. [70][71][72][73][74] fRBCs stored in vitro have generally shown superior quality measures, such as less susceptibility to storage-induced hemolysis and mechanical fragility, and better rheologic properties compared to mRBCs 22,75 that can be related to a larger proportion of biologically younger RBCs in female donors. 22,76 This study also revealed the effect of donor sex on structural and functional properties of the RBCs by demonstrating the following: fRBCs have greater size and intracellular ROS, Ca 2+ , and HGB and lower MCHC, hemolysis, and membrane rigidity compared to mRBCs.…”

Section: Intracellular Reactive Oxygen Species and Ca 2+ In Rbcs Dumentioning

confidence: 99%

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Donor‐dependent aging of young and old red blood cell subpopulations: Metabolic and functional heterogeneity

et al. 2020

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Background: Characteristics of red blood cells (RBCs) are influenced by donor variability. This study assessed quality and metabolomic variables of RBC subpopulations of varied biologic age in red blood cell concentrates (RCCs) from male and female donors to evaluate their contribution to the storage lesion. Study Design and Methods: Red blood cell concentrates from healthy male (n = 6) and female (n = 4) donors were Percoll separated into less dense ("young", Y-RCCs) and dense ("old", O-RCCs) subpopulations, which were assessed weekly for 28 days for changes in hemolysis, mean cell volume (MCV), hemoglobin concentration (MCHC), hemoglobin autofluorescence (HGB), morphology index (MI), oxygen affinity (p50), rigidity, intracellular reactive oxygen species (ROS), calcium ([Ca 2+ ]), and mass spectrometry-based metabolomics. Results: Young RCCs having disc-to-discoid morphology showed higher MCV and MI, but lower MCHC, HGB, and rigidity than O-RCCs, having discoid-tospheroid shape. By Day 14, Y-RCCs retained lower hemolysis and rigidity and higher p50 compared to O-RCCs. Donor sex analyses indicated that females had higher MCV, HGB, ROS, and [Ca 2+ ] and lower hemolysis than male RBCs, in addition to having a decreased rate of change in hemolysis by Day 28. Metabolic profiling indicated a significant sex-related signature across all groups with increased markers of high membrane lipid remodeling and antioxidant capacity in Y-RCCs, whereas O-RCCs had increased markers of oxidative stress and decreased coping capability. Conclusion: The structural, functional, and metabolic dissimilarities of Y-RCCs and O-RCCs from female and male donors demonstrate RCC heterogeneity, where RBCs from females contribute less to the storage lesion and age slower than males.

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Section: Discussionmentioning

confidence: 99%

Section: Intracellular Reactive Oxygen Species and Ca 2+ In Rbcs Dumentioning

confidence: 99%

Donor‐dependent aging of young and old red blood cell subpopulations: Metabolic and functional heterogeneity

et al. 2020

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Section: Donor–recipient Sex Concordance In Rbcsmentioning

confidence: 99%

“…There is clearly a need to further elucidate underlying mechanisms that could inform best practices and explain a potential mortality difference. 9…”

Section: Donor–recipient Sex Concordance In Rbcsmentioning

confidence: 99%

“…These differences are proposed to have an impact on oxygen delivery, hemodynamics, coagulation, and extracellular vesicles, which together could explain the mortality difference found in most studies of sex-discordant transfusions. 9 It is clear that donated RBCs differ between sexes, and despite most studies finding a slight mortality increase in sex-mismatched blood, blood banks have not moved to update RBC transfusion protocols. There is clearly a need to further elucidate underlying mechanisms that could inform best practices and explain a potential mortality difference.…”

Section: Donor-recipient Sex Concordance In Rbcsmentioning

confidence: 99%

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Sex- and Gender-Related Factors in Blood Product Transfusions

Zimmerman

McGregor

2020

Gender and the Genome

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Blood products are indicated for a plethora of conditions in several settings, with a variety of products available for transfusion, from highly processed specific components to whole blood. Matching the donor product to the recipient is crucial in avoiding serious transfusion reactions, with the extent of matching depending on the physiological need, setting, and product. There are important factors related to sex and gender differences in donated blood products, adverse reactions to those products, interplay with underlying pathology, as well as sociocultural differences in the collection. This article will review key sex- and gender-specific research related to the use of blood products with an emphasis on the acute care setting.

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