Donor-recipient sex is associated with transfusion-related outcomes in critically ill patients

Abstract

Transfusion of red blood cell (RBC) from female donors has been associated with increased risk of mortality. This study aims to investigate the associations between donor-recipient sex and post-transfusion mortality and morbidity in critically ill patients who received RBC transfusions from either male only donors or from female only donors (unisex-transfusion cases). Survival analysis was used to compare 4 groups: female-to-female, female-to-male, male-to-female, and male-to-male transfusion. Multivariate logistic model was used to evaluate the association between donor sex and ICU mortality. Associations between transfusion and acute kidney injury (AKI), acute respiratory distress syndrome (ARDS) and nosocomial infections were assessed. Of the 6992 patients included in the original cohort study, 403 patients received unisex-transfusion. Survival analysis and the logistic model showed that transfusion of female RBCs to male patients was associated with an increased ICU mortality compared to transfusion of female RBCs to female patients (OR 2.43; 95% CI 1.02- 5.77; p-value < 0.05). There was a trend towards increased ARDS in patients receiving RBC from female donors compared to those receiving blood from males (p-value = 0.06) while AKI was higher in donor-recipient sex-matched transfusion groups compared to sex-mismatched groups (p-value = 0.05). This was an exploratory study with potential uncontrolled confounders that limits broad generalization of the findings. Results warrant further studies investigating biological mechanisms underlying the association between donor sex with adverse outcomes as well as studies on the benefit of matching of blood between donor and recipient.

Mass spectrometry‐based analysis on the impact of whole blood donation on the global plasma proteome

“…We also observed previously described differences between female and male donors in PZP levels, which is in line with several previous publications that PZP plasma levels are a proxy for sex 15,22,23 . This may be important in the context of sex‐related factors in blood product transfusions 24–26 . In this study, we also show that circulating plasma protein levels correlate with other blood count parameters (e.g., WBC and LBP).…”

“…15,22,23 This may be important in the context of sex-related factors in blood product transfusions. [24][25][26] In this study, we also show that circulating plasma protein levels correlate with other blood count parameters (e.g., WBC and LBP). Furthermore, we observed individual plasma protein signatures which are related to the immunological status, including donor-specific immunoglobulin D levels (Figure 2B).…”

Is donor-recipient sex associated with transfusion-related outcomes in critically ill patients?

“…Alshalani et al 1 state in their recent article that the transfusion of red blood cells (RBCs) from female donors to male recipients vs female recipients increases the risk of intensive care unit (ICU) mortality, and that receiving RBCs from female donors is associated with a trend toward acute respiratory distress syndrome. The comparison between male and female recipients of female donor RBCs and its presentation in the visual abstract is misleading.…”

Transfusion transmissible infections among blood donors in Ghana: A 3‐year multicentered health facility‐based retrospective study

“…Also, it is likely most females may not be able to donate blood due to childbirth, pregnancy, anemia, and lactation. Some studies have reported an increased risk of mortality among critically ill blood recipients from ever‐pregnant female donors 42–44 . It is however unclear whether this could be a contributory factor to the low patronage of female in blood donation.…”