Ever-Pregnant Female Blood Donors and Mortality Risk in Male Recipients

Ali, Omer; Wasfi, Mohamed Fawzi; Uzoigwe, Chika Edward

doi:10.1001/jama.2017.21852

Cited by 6 publications

(6 citation statements)

References 3 publications

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“…This study showed an association between death and transfusion of RBCs from ever‐pregnant female donors given to males but not among female recipients. Several letters to the editor raised questions about some of the methodological approaches used in this study, with responses from the authors justifying their methodological decisions …”

Section: Discussionmentioning

confidence: 99%

The association between blood donor sex and age and transfusion recipient mortality: an exploratory analysis

et al. 2018

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BACKGROUND There is recent support for long‐term adverse effects of donor‐recipient sex‐mismatched red blood cell (RBC) transfusion, but short‐term impact is unknown. A retrospective exploratory analysis was performed using data from a research database. METHODS Adults admitted to hospitals in one Canadian center who received RBCs (2008–2014 [3 sites]; 2012–2014 [1 site]) were eligible. Patient data were extracted from a research database and donor data from the blood supplier. Cox regression models were used, with control of risk and confounding variables as covariates or using stratification. Exposure was defined by mutually exclusive categories. The outcome was in‐hospital mortality. RESULTS A total of 25,219 adults received 97,886 RBCs. Diagnoses included cardiovascular (28.8%), neoplastic (15.6%), traumatic (15.4%), or gastrointestinal (10.5%); 56.3% of transfused RBCs were male donors, and median donor age was 45 years (interquartile range, 30–54). Female patients exposed to male RBCs experienced a higher risk of in‐hospital death (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.02–1.69; p = 0.038) compared to exclusive female RBC exposure. Exposure to RBCs from donors aged 45 years or younger was associated with a higher in‐hospital death (HR, 1.21; 95% CI, 1.02–1.44; p = 0.026) compared to exclusive RBC exposure to donors older than 45 years. Donor‐recipient sex‐mismatched RBC exposure (vs. exclusively sex‐matched) and RBC exposure from donors aged 45 years or younger (vs. exclusively RBCs from donors >45) were associated with increased mortality: sex‐mismatched (HR, 1.23; (95% CI, 1.04–1.45; p = 0.017); donors aged 45 years or younger (HR, 1.21; (95% CI, 1.02–1.43; p = 0.031). CONCLUSION Donor‐recipient sex‐matched RBC transfusions and transfusions from older donors may benefit patients.

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Section: Discussionmentioning

confidence: 99%

The association between blood donor sex and age and transfusion recipient mortality: an exploratory analysis

et al. 2018

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“…Four studies (three published [9][10][11] and one under review [preliminary report at 2018 ISBT]) explored an association between donor characteristics (age, sex, or history of pregnancy) and recipient mortality. Figure 1 shows the timeline of study publications, editorials, 12,13 and letters to the editor [14][15][16][17][18] illustrating the interest generated by these studies and the need for exercising statistical caution in using big data. Study results have been discordant: some have shown harm from exposure to RBCs from female donors, female donors with a history of pregnancy, and/or younger donors, whereas others have not observed these associations.…”

Section: Big Data and Donor Characteristicsmentioning

confidence: 99%

“…The FDA recently approved two new cellular therapies manufactured from a patient's lymphocytes via apheresis mononuclear cell collection. These novel autologous therapies involve the production of T cells that have been genetically modified to [14][15][16][17][18][19][20][21][22]). The groups did not differ in mortality at 28 days (15% in the plasma group vs. 10% in the control group; p = 0.37).…”

Section: Chimeric Antigen Receptor T-cell Therapymentioning

confidence: 99%

Critical developments of 2018: A review of the literature from selected topics in transfusion. A committee report from the AABB's Clinical Transfusion Medicine Committee

et al. 2019

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RESULTS:The following topics are covered: "big data"and "omics" studies, emerging infections and testing, platelet transfusion and pathogen reduction, transfusion therapy and coagulation, transfusion approach to hemorrhagic shock and mass casualties, therapeutic apheresis, and chimeric antigen receptor T-cell therapy. CONCLUSION:This synopsis may be a useful educational tool. ABBREVIATIONS: ARC = American Red Cross; CAR = chimeric antigen receptor; CJD = Creutzfeldt-Jakob disease; CRS = cytokine release syndrome; DENV = Dengue virus; FDA = US Food and Drug Administration; IgM = immunoglobulin M; IRIS = immune reconstitution inflammatory syndrome; NAT = nucleic acid testing; NTZ = natalizumab; NTZ-PML = NTZ-associated PML; PAS = platelets in additive solution; PCR = polymerase chain reaction; PML = progressive multifocal leukoencephalopathy; PR = pathogen reduction; RCT = randomized controlled trial; TMA = transcriptionmediated amplification; TPE = therapeutic plasma exchange; TTP = thrombotic thrombocytopenic purpura; ZIKV = Zika virus. From the

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“…For example, trauma patients are predominantly young and male (<50 years of age), frequently receive more RBCs, and have higher rates of massive transfusion. 38 These patients are also more likely to receive multiple types of blood components and have different mortality rates than the general transfused population. Again, merging data from multiple cohorts or inclusion of national level datasets without missing data may provide additional statistical power to conduct such subgroup analyses.…”

mentioning

confidence: 99%

“…In addition, specific patient subgroup analyses may be additionally prone to residual confounding. For example, trauma patients are predominantly young and male (<50 years of age), frequently receive more RBCs, and have higher rates of massive transfusion [38]. These patients are also more likely to receive multiple types of blood components and have different mortality rates than the general transfused population.…”

mentioning

confidence: 99%

Methodological considerations for linked blood donor‐component‐recipient analyses in transfusion medicine research

Roubinian

Kleinman

Murphy

et al. 2019

ISBT Science Series

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In recent years, there has been a concerted effort to improve our understanding of the quality and effectiveness of transfused blood components. The expanding use of large datasets built from electronic health records allows the investigation of potential benefits or adverse outcomes associated with transfusion therapy. Together with data collected on blood donors and components, these datasets permit an evaluation of associations between donor or blood component factors and transfusion recipient outcomes. Large linked donor-component recipient datasets provide the power to study exposures relevant to transfusion efficacy and safety, many of which would not otherwise be amenable to study for practical or sample size reasons. Analyses of these large blood banking-transfusion medicine datasets allow for characterization of the populations under study and provide an evidence base for future clinical studies. Knowledge generated from linked analyses have the potential to change the way donors are selected and how components are processed, stored and allocated. However, unrecognized confounding and biased statistical methods continue to be limitations in the study of transfusion exposures and patient outcomes. Results of observational studies of blood donor demographics, storage age, and transfusion practice have been conflicting. This review will summarize statistical and methodological challenges in the analysis of linked blood donor, component, and transfusion recipient outcomes.In the past three decades, there has been a concerted effort to improve our understanding of the quality, safety, and effectiveness of transfused blood components. [1][2][3] Significant research has focused on blood donors, on component manufacturing and storage, and optimal

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Ever-Pregnant Female Blood Donors and Mortality Risk in Male Recipients

Cited by 6 publications

References 3 publications

The association between blood donor sex and age and transfusion recipient mortality: an exploratory analysis

The association between blood donor sex and age and transfusion recipient mortality: an exploratory analysis

Critical developments of 2018: A review of the literature from selected topics in transfusion. A committee report from the AABB's Clinical Transfusion Medicine Committee

Methodological considerations for linked blood donor‐component‐recipient analyses in transfusion medicine research

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