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Valk SJ, Caram-Deelder C, Groenwold RHH, Evers D, De Vooght KMK, Van de Kerkhof D, Wondergem MJ, Péquériaux NCV, Hudig F, Zwaginga JJ, Middelburg RA, Van der Bom JG. Transfusion of ever-pregnant donor red blood cells and mortality of male patients. Haematologica 2024; 109:2478-2486. [PMID: 38385259 PMCID: PMC11290512 DOI: 10.3324/haematol.2023.283550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 02/14/2024] [Indexed: 02/23/2024] Open
Abstract
Previous studies found exposure to red blood cell transfusions from female donors who have been pregnant reduces survival in male patients compared to exposure to male donor products, but evidence is not consistent. We postulate the previously observed association is modified by offspring sex, with an expected increased mortality risk for male patients receiving units from female donors with sons. Here, marginal structural models were used to assess the association between exposure to units from ever-pregnant donors, ever-pregnant donors with sons and ever-pregnant donors with daughters, and mortality. Clinical data were collected on first-ever transfusion recipients in the Netherlands and donor data were supplemented with information about offspring sex and date of birth. In this analysis, 56,825 patients were included, of whom 8,288 died during follow-up. Exposure to red blood cell units from ever-pregnant donors with sons was not associated with increased all-cause mortality risk among male transfusion recipients (hazard ratio [HR]=0.91, 95% confidence interval [CI]: 0.83-1.01). Exposure to ever-pregnant donors, irrespective of offspring sex, was associated with mortality in male patients aged between 18 and 50 years (ever-pregnant donors: HR=1.81, 95% CI: 1.31-2.51) compared to male donor units, but was protective in female patients. This study suggests that the observed increased mortality risk for exposure to red blood cell units from parous female donors does not depend on offspring sex. The increased risk of mortality seen in younger adult male patients is consistent with previous observations, but the underlying biological mechanism could not be identified in this study.
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Affiliation(s)
- Sarah J Valk
- Jon J van Rood Center for Clinical Transfusion Research, Sanquin/LUMC, Leiden, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden
| | | | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden
| | | | | | - Daan Van de Kerkhof
- Department of Clinical Chemistry and Haematology, Catharina Hospital, Eindhoven
| | | | | | | | - Jaap Jan Zwaginga
- Jon J van Rood Center for Clinical Transfusion Research, Sanquin/LUMC, Leiden, The Netherlands; Department of Haematology, Leiden University Medical Center, Leiden
| | - Rutger A Middelburg
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden
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2
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Valk SJ, Caram-Deelder C, Evers D, de Vooght KMK, van de Kerkhof D, Wondergem MJ, Péquériaux NCV, Hudig F, Zwaginga JJ, de Korte D, van de Watering LMG, Middelburg RA, van der Bom JG. Donor pregnancies and transfusion recipient mortality: A role for red blood cell storage? Vox Sang 2024; 119:43-52. [PMID: 37920882 DOI: 10.1111/vox.13551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/01/2023] [Accepted: 10/08/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Donor characteristics have been implicated in transfusion-related adverse events. Uncertainty remains about whether sex, and specifically pregnancy history of the blood donor, could affect patient outcomes. Whether storage duration of the blood product could be important for patient outcomes has also been investigated, and a small detrimental effect of fresh products remains a possibility. Here, we hypothesize that fresh red blood cell products donated by ever-pregnant donors are associated with mortality in male patients. MATERIALS AND METHODS We used data from a cohort study of adult patients receiving a first transfusion between 2005 and 2015 in the Netherlands. The risk of death after receiving a transfusion from one of five exposure categories (female never-pregnant stored ≤10 days, female never-pregnant stored >10 days, female ever-pregnant stored ≤10 days, female ever-pregnant stored >10 days and male stored for ≤10 days), compared to receiving a unit donated by a male donor, which was stored for >10 days (reference), was calculated using a Cox proportional hazards model. RESULTS The study included 42,456 patients who contributed 88,538 person-years in total, of whom 13,948 died during the follow-up of the study (33%). Fresh units (stored for ≤10 days) from ever-pregnant donors were associated with mortality in male patients, but the association was not statistically significant (hazard ratio 1.39, 95% confidence interval 0.97-1.99). Sensitivity analyses did not corroborate this finding. CONCLUSION These findings do not consistently support the notion that the observed association between ever-pregnant donor units and mortality is mediated by blood product storage.
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Affiliation(s)
- Sarah J Valk
- Jon J van Rood Center for Clinical Transfusion Research, Sanquin/LUMC, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Camila Caram-Deelder
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dorothea Evers
- Department of Haematology, Radboudumc, Nijmegen, The Netherlands
| | - Karen M K de Vooght
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daan van de Kerkhof
- Department of Clinical Chemistry and Haematology, Catharina Hospital, Eindhoven, The Netherlands
| | - Marielle J Wondergem
- Department of Haematology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Nathalie C V Péquériaux
- Department of Clinical Chemistry and Haematology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | - Jaap Jan Zwaginga
- Jon J van Rood Center for Clinical Transfusion Research, Sanquin/LUMC, Leiden, The Netherlands
- Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dirk de Korte
- Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, The Netherlands
- Department of Blood Cell Research, Sanquin Research, and Landsteiner Laboratory, University of Amsterdam, Amsterdam, The Netherlands
| | - Leo M G van de Watering
- Jon J van Rood Center for Clinical Transfusion Research, Sanquin/LUMC, Leiden, The Netherlands
- Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, The Netherlands
| | - Rutger A Middelburg
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Johanna G van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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3
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Salem A, Patel RM. Blood Donor Sex and Outcomes in Transfused Infants. Clin Perinatol 2023; 50:805-820. [PMID: 37866849 PMCID: PMC10688602 DOI: 10.1016/j.clp.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Red blood cell transfusion is common in neonatal intensive care. Multiple trials have evaluated different thresholds for when to administer red blood cell transfusion. In contrast, there has been less focus on studies of the characteristics of red blood cells transfused into neonates. In this review, the authors summarize the emerging literature on the potential impact of the sex of blood donors on outcomes in transfused neonates using a systematic search strategy. The authors review the uncertainty generated from studies with conflicting findings and discuss considerations regarding the impact of blood donor sex and other characteristics on neonatal outcomes.
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Affiliation(s)
- Anand Salem
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, 2015 Uppergate Drive Northeast, Atlanta, GA 30322, USA
| | - Ravi Mangal Patel
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, 2015 Uppergate Drive Northeast, Atlanta, GA 30322, USA.
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Crowe EP, Goel R, Al-Mozain N, Josephson CD. Neonatal Blood Banking Practices. Clin Perinatol 2023; 50:821-837. [PMID: 37866850 DOI: 10.1016/j.clp.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
There is little formal guidance to direct neonatal blood banking practices and, as a result, practices vary widely across institutions. In this vulnerable patient population with a high transfusion burden, considerations for blood product selection include freshness, extended-storage media, pathogen inactivation, and other modifications. The authors discuss the potential unintended adverse impacts in the neonatal recipient. Concerns such as immunodeficiency, donor exposures, cytomegalovirus transmission, volume overload, transfusion-associated hyperkalemia, and passive hemolysis from ABO incompatibility have driven modifications of blood components to improve safety.
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Affiliation(s)
- Elizabeth P Crowe
- Department of Pathology, Johns Hopkins University School of Medicine, 1800 Orleans Street, Sheikh Zayed Tower, Room 3081-A, Baltimore, MD 21287, USA
| | - Ruchika Goel
- Corporate Medical Affairs, Vitalant National Office, Scottsdale, AZ, USA; Division of Hematology/Oncology, Department of Internal Medicine and Pediatrics, Simmons Cancer Institute at SIU School of Medicine, 704 Lismore Lane, Springfield, IL 62704, USA; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nour Al-Mozain
- Hematopathology & Transfusion Medicine, Department of Pathology & Laboratory Medicine, King Faisal Specialist Hospital & Research Centre, 7652, Riyadh, Riyadh, 12713, Saudi Arabia; Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Cassandra D Josephson
- Department of Oncology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Cancer and Blood Disorders Institute, Blood Bank and Transfusion Medicine, Department of Pathology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
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5
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Alshalani A, de Wissel MB, Tuip-de Boer AM, Roelofs JJTH, van Bruggen R, Acker JP, Juffermans NP. Transfusion of female blood in a rat model is associated with red blood cells entrapment in organs. PLoS One 2023; 18:e0288308. [PMID: 37992035 PMCID: PMC10664878 DOI: 10.1371/journal.pone.0288308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/25/2023] [Indexed: 11/24/2023] Open
Abstract
Transfusion of red blood cells (RBCs) has been associated with adverse outcomes. Mechanisms may be related to donor sex and biological age of RBC. This study hypothesized that receipt of female blood is associated with decreased post-transfusion recovery (PTR) and a concomitant increased organ entrapment in rats, related to young age of donor RBCs. Donor rats underwent bloodletting to stimulate production of new, young RBCs, followed by Percoll fractionation for further enrichment of young RBCs based on their low density. Control donors did not undergo these procedures. Male rats received either a (biotinylated) standard RBC product or a product enriched for young RBCs, derived from either male or female donors. Controls received saline. Organs and blood samples were harvested after 24 hours. This study found no difference in PTR between groups, although only the group receiving young RBCs from females failed to reach a PTR of 75%. Receipt of both standard RBCs and young RBCs from females was associated with increased entrapment of donor RBCs in the lung, liver, and spleen compared to receiving blood from male donors. Soluble ICAM-1 and markers of hemolysis were higher in recipients of female blood compared to control. In conclusion, transfusing RBCs from female donors, but not from male donors, is associated with trapping of donor RBCs in organs, accompanied by endothelial activation and hemolysis.
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Affiliation(s)
- Abdulrahman Alshalani
- Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marit B. de Wissel
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anita M. Tuip-de Boer
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joris J. T. H. Roelofs
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, The Netherlands
| | - Robin van Bruggen
- Department of Molecular Hematology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jason P. Acker
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Nicole P. Juffermans
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Intensive Care, OLVG Hospital, Amsterdam, the Netherlands
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Walana W, Vicar EK, Kuugbee ED, Dari I, Bichenlib G, Aneba CN, Hinneh KN, Yabasin IB, Issaka KN, Danso MO, Amoatey TN, Ziem JB. Transfusion transmissible infections among blood donors in Ghana: A 3-year multicentered health facility-based retrospective study. Health Sci Rep 2023; 6:e1681. [PMID: 37927541 PMCID: PMC10620378 DOI: 10.1002/hsr2.1681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023] Open
Abstract
Transfusion transmissible infections (TTIs) remain a major health challenge particularly in developing countries. Here, we present a multicentered hospital-based retrospective study on the prevalence, distribution, and risk factors of TTIs in Ghana. Data on blood donors from four health facilities, namely Nkwanta South Municipal Hospital (Oti region), Weija-Gbawe Municipal Hospital (Greater Accra region), SDA Hospital (Northern region) and Wa Municipal Hospital (Upper West region) were extracted and analyzed. Descriptive statistics and multinomial logistic regression were applied to compare sociodemographic data with TTI status. A total of 6094 blood donors were included in this study, and 2% were females. The overall prevalence of TTIs was 21.0% (1232/5868). Specifically, the prevalence of HBV, HCV, HIV, and Syphilis was 6.6% (385/5868), 4.9% (286/5830), 2.9% (168/5867), and 6.8% (393/5739), respectively. Wa dominated in all the viral agents considered in this study, while the Oti region recorded the highest prevalence in T. pallidum. The odds of HBV infection was 3.1 (p = 0.008) among first-time donors, while that for HCV was 2.8 (p = 0.042). For rural dwellers, donors significantly had T. pallidum (p < 0.001; OR = 2.8), HCV (p < 0.001; OR = 2.9), and HIV (p = 0.028; OR = 1.5) infections. Generally, the recipients of transfused blood were predominantly pregnant mothers, followed by children and accident victims. This study has revealed significant disparities and relatively high prevalence of TTIs in Ghana, specifically HBV, HCV, HIV and T. pallidum infections. The variations suggest the presence of unique health challenges per study area, hence the need for a tailored intervention for each study site.
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Affiliation(s)
- Williams Walana
- Department of Clinical MicrobiologySchool of Medicine, University for Development StudiesTamaleGhana
| | - Ezekiel K. Vicar
- Department of Clinical MicrobiologySchool of Medicine, University for Development StudiesTamaleGhana
| | - Eugene D. Kuugbee
- Department of Microbiology and ImmunologySchool of Medicine and DentistryNavrongoGhana
| | - Isaac Dari
- Community Health and Preventive MedicineSchool of Medicine, University for Development StudiesTamaleGhana
| | - Grace Bichenlib
- Community Health and Preventive MedicineSchool of Medicine, University for Development StudiesTamaleGhana
| | - Christian N. Aneba
- Community Health and Preventive MedicineSchool of Medicine, University for Development StudiesTamaleGhana
| | - Kwasi N. Hinneh
- Community Health and Preventive MedicineSchool of Medicine, University for Development StudiesTamaleGhana
| | - Iddrisu B. Yabasin
- Department of Anaesthesiology and Intensive CareUniversity for Development StudiesTamaleGhana
| | - Koray N. Issaka
- Department of Laboratory ServiceWa Municipal Hospital, Upper West RegionWaGhana
| | - Michael O. Danso
- Department of Laboratory ServiceWeija‐Gbawe Municipal Hospital, Greater Accra RegionAccraGhana
| | | | - Juventus B. Ziem
- Department of Microbiology and ImmunologySchool of Medicine and DentistryNavrongoGhana
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7
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Gaiffe E, Vernerey D, Bardiaux L, Leroux F, Meurisse A, Bamoulid J, Courivaud C, Saas P, Hazzan M, Tiberghien P, Ducloux D. Transfused Red Blood Cell Characteristics and Kidney Transplant Outcomes Among Patients Receiving Early Posttransplant Transfusion. JAMA Netw Open 2023; 6:e2332821. [PMID: 37707816 PMCID: PMC10502525 DOI: 10.1001/jamanetworkopen.2023.32821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/27/2023] [Indexed: 09/15/2023] Open
Abstract
Importance Red blood cell transfusion (RBCT) is frequently required in the early post-kidney transplant period, but long-term outcomes associated with RBCT is controversial. Therefore, it may be relevant to investigate the association between RBCT characteristics and transplant outcomes. Objective To study the association between RBC storage duration and transplant outcomes. Design, Setting, and Participants This was a nationwide retrospective cohort study based on data linking between 2 prospective French nationwide registries. Clinical transplant parameters, outcomes, and RBCT characteristics were extracted from the CRISTAL registry of the Agence de la Biomédecine and the national database of the Etablissement Français du Sang. All 12 559 patients having received a first kidney transplant in France between January 1, 2002, and December 31, 2008, were included. Patients were followed up from transplant to graft loss, death with a functional graft, or data retrieval in June 2016. Data were analyzed from April 2019 to June 2022. Exposures Clinical outcomes of transplant recipients who underwent early RBCT were analyzed considering transfusion characteristics. Main Outcomes and Measures Cox proportional hazards regression models were fitted to evaluate transplant failure defined as graft loss or death with a functional graft. Results Among 12 559 patients who underwent kidney transplant, 3483 received an RBCT during the first 14 days posttransplant. The median (IQR) age of patients was 53.0 (41.5-61.2) years, and 1929 patients (55.4%) were male. Median (IQR) follow-up was 7.8 (7.6-8.0) years. In multivariable analysis, longer (vs shorter) storage duration of transfused RBC was associated with a decrease in risk of transplant failure (hazard ratio, 0.99; 95% CI, 0.98-1.00 for each additional storage day; P = .06). Patients transfused with at least 1 RBC unit stored for more than 20 days had a 5% absolute decrease in transplant failure at 3 years and 7% at 5 years compared with those who received RBC stored for less than 20 days. Conclusions and Relevance In this study, longer RBC storage duration was associated with a decreased risk of transplant failure among patients who received kidney transplants and RBC transfusions. Preferential use of RBC with longer storage duration might improve kidney graft survival following transplant and transfusion.
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Affiliation(s)
- Emilie Gaiffe
- Franche-Comté University, Besançon University Hospital, Etablissement Français du Sang Bourgogne Franche-Comté, INSERM, Unité Mixte de Recherche 1098, RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Dewi Vernerey
- Franche-Comté University, Besançon University Hospital, Etablissement Français du Sang Bourgogne Franche-Comté, INSERM, Unité Mixte de Recherche 1098, RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
- Methodology and Quality of Life in Oncology Unit, Centre Hospitalier Universitaire Besançon, Besançon, France
| | | | - Franck Leroux
- INSERM CIC-1431, Centre Hospitalier Universitaire Besançon, Besançon, France
| | - Aurelia Meurisse
- Franche-Comté University, Besançon University Hospital, Etablissement Français du Sang Bourgogne Franche-Comté, INSERM, Unité Mixte de Recherche 1098, RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
- Methodology and Quality of Life in Oncology Unit, Centre Hospitalier Universitaire Besançon, Besançon, France
| | - Jamal Bamoulid
- Franche-Comté University, Besançon University Hospital, Etablissement Français du Sang Bourgogne Franche-Comté, INSERM, Unité Mixte de Recherche 1098, RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
- Service de Néphrologie, Centre Hospitalier Universitaire Besançon, Besançon, France
| | - Cecile Courivaud
- Franche-Comté University, Besançon University Hospital, Etablissement Français du Sang Bourgogne Franche-Comté, INSERM, Unité Mixte de Recherche 1098, RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
- Service de Néphrologie, Centre Hospitalier Universitaire Besançon, Besançon, France
| | - Philippe Saas
- Franche-Comté University, Besançon University Hospital, Etablissement Français du Sang Bourgogne Franche-Comté, INSERM, Unité Mixte de Recherche 1098, RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
- INSERM CIC-1431, Centre Hospitalier Universitaire Besançon, Besançon, France
| | - Marc Hazzan
- Nephrology and Transplant department, Lille University Hospital, Lille, France
| | - Pierre Tiberghien
- Franche-Comté University, Besançon University Hospital, Etablissement Français du Sang Bourgogne Franche-Comté, INSERM, Unité Mixte de Recherche 1098, RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
- Etablissement Français du Sang, La Plaine St Denis, France
| | - Didier Ducloux
- Franche-Comté University, Besançon University Hospital, Etablissement Français du Sang Bourgogne Franche-Comté, INSERM, Unité Mixte de Recherche 1098, RIGHT Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
- Service de Néphrologie, Centre Hospitalier Universitaire Besançon, Besançon, France
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8
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Crawford T, Andersen C, Marks DC, Robertson SA, Stark M. Does donor sex influence the potential for transfusion with washed packed red blood cells to limit transfusion-related immune responses in preterm newborns? Arch Dis Child Fetal Neonatal Ed 2023; 108:471-477. [PMID: 36690436 DOI: 10.1136/archdischild-2022-324531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 01/06/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate the association of donor sex with transfusion-associated recipient immune responses in preterm newborns receiving unwashed and washed blood. DESIGN A cohort study using data collected during the Effect of Washed versus Unwashed Packed Red Blood Cell Transfusion on Immune Responses in the Extremely Preterm Newborn randomised trial. SETTING Participants were recruited from two South Australian hospitals between September 2015 and December 2020. PATIENTS Preterm newborns (<29 weeks). INTERVENTIONS Transfusion with unwashed and washed packed red blood cells (PRBCs) from either exclusively male or any female donor for the first three transfusions. MAIN OUTCOMES MEASURES The primary outcome was the change from baseline in post-transfusion plasma cytokine concentrations, specifically interferon gamma, interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12, IL-17A and tumour necrosis factor (TNF). RESULTS In total, 153 newborns were evaluated. By the third transfusion, the magnitude of pretransfusion to post-transfusion change in cytokines between the groups differed for IL-6 (p=0.003), IL-12 (p=0.008), IL-17A (p=0.003) and TNF (p=0.007). On post hoc comparison, compared with the unwashed-any female donor group, IL-6 (p<0.05), IL-12 (p<0.05) and IL-17A (p<0.01) were lower in the washed-exclusively male donor group, and IL-6 (p<0.01), IL-12 (p<0.05) and TNF (p<0.01) were lower in the washed-any female donor group. CONCLUSION These findings suggest that transfusion with unwashed PRBCs from female donors is associated with an increased recipient immune response, an effect that can be ameliorated with pretransfusion washing. Larger randomised controlled studies confirming this mechanistic link between donor sex and transfusion-associated morbidity are warranted. TRIAL REGISTRATION NUMBER ACTRN12613000237785.
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Affiliation(s)
- Tara Crawford
- Neonatal Medicine, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
- The University of Adelaide Robinson Research Institute, North Adelaide, South Australia, Australia
| | - Chad Andersen
- Neonatal Medicine, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
- The University of Adelaide Robinson Research Institute, North Adelaide, South Australia, Australia
| | - Denese C Marks
- Product Development and Storage, Australian Red Cross Blood Service New South Wales and Australian Capital Territory, Alexandria, New South Wales, Australia
| | - Sarah A Robertson
- The University of Adelaide Robinson Research Institute, North Adelaide, South Australia, Australia
| | - Michael Stark
- Neonatal Medicine, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
- The University of Adelaide Robinson Research Institute, North Adelaide, South Australia, Australia
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9
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Chassé M, Fergusson DA, Tinmouth A, Acker JP, Perelman I, Tuttle A, English SW, Hawken S, Forster AJ, Shehata N, Thavorn K, Wilson K, Cober N, Maddison H, Tokessy M. Effect of Donor Sex on Recipient Mortality in Transfusion. N Engl J Med 2023; 388:1386-1395. [PMID: 37043654 DOI: 10.1056/nejmoa2211523] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Conflicting observational evidence exists regarding the association between the sex of red-cell donors and mortality among transfusion recipients. Evidence to inform transfusion practice and policy is limited. METHODS In this multicenter, double-blind trial, we randomly assigned patients undergoing red-cell transfusion to receive units of red cells from either male donors or female donors. Patients maintained their trial-group assignment throughout the trial period, including during subsequent inpatient and outpatient encounters. Randomization was conducted in a 60:40 ratio (male donor group to female donor group) to match the historical allocation of red-cell units from the blood supplier. The primary outcome was survival, with the male donor group as the reference group. RESULTS A total of 8719 patients underwent randomization before undergoing transfusion; 5190 patients were assigned to the male donor group, and 3529 to the female donor group. At baseline, the mean (±SD) age of the enrolled patients was 66.8±16.4 years. The setting of the first transfusion was as an inpatient in 6969 patients (79.9%), of whom 2942 (42.2%) had been admitted under a surgical service. The baseline hemoglobin level before transfusion was 79.5±19.7 g per liter, and patients received a mean of 5.4±10.5 units of red cells in the female donor group and 5.1±8.9 units in the male donor group (difference, 0.3 units; 95% confidence interval [CI], -0.1 to 0.7). Over the duration of the trial, 1141 patients in the female donor group and 1712 patients in the male donor group died. In the primary analysis of overall survival, the adjusted hazard ratio for death was 0.98 (95% CI, 0.91 to 1.06). CONCLUSIONS This trial showed no significant difference in survival between a transfusion strategy involving red-cell units from female donors and a strategy involving red-cell units from male donors. (Funded by the Canadian Institutes of Health Research; iTADS ClinicalTrials.gov number, NCT03344887.).
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Affiliation(s)
- Michaël Chassé
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Dean A Fergusson
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Alan Tinmouth
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Jason P Acker
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Iris Perelman
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Angie Tuttle
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Shane W English
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Steven Hawken
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Alan J Forster
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Nadine Shehata
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Kednapa Thavorn
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Kumanan Wilson
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Nancy Cober
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Heather Maddison
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
| | - Melanie Tokessy
- From the Department of Medicine, Centre Hospitalier de l'Université de Montréal, and the Department of Medicine, Faculty of Medicine, and the School of Public Health, Université de Montréal, Montreal (M.C.), the Clinical Epidemiology Program, Ottawa Hospital Research Institute (D.A.F., A. Tinmouth, I.P., A. Tuttle, S.W.E., S.H., A.J.F., K.T.), the Department of Medicine (D.A.F., A. Tinmouth, S.W.E., A.J.F., K.W.), and the School of Epidemiology and Public Health (D.A.F., S.H., K.T., K.W.), University of Ottawa, Canadian Blood Services (D.A.F., A. Tinmouth, J.P.A.), Bruyère Research Institute (K.W.), and the Ottawa Hospital (N.C., H.M., M.T.), Ottawa, the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (J.P.A.), and ICES (formerly the Institute for Clinical Evaluative Sciences) (S.H., A.J.F., K.T.), the Dalla Lana School of Public Health and the Department of Medicine, University of Toronto (N.S.), and the Department of Medicine, University Health Network (N.S.), Toronto - all in Canada
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10
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Alshalani A, Beuger BM, Tuip-de Boer AM, van Bruggen R, Acker JP, Juffermans NP. The impact of biological age of red blood cell on in vitro endothelial activation markers. Front Physiol 2023; 14:1127103. [PMID: 36969576 PMCID: PMC10030615 DOI: 10.3389/fphys.2023.1127103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/23/2023] [Indexed: 03/10/2023] Open
Abstract
Introduction: Blood donor characteristics influence red blood cell transfusion outcomes. As donor sex affects the distribution of young to old RBCs in the circulation, we hypothesized that the amount of circulating young RBCs in the blood product are associated with immune suppression.Materials and Methods: Blood samples were collected from healthy volunteers and density fractionated into young and old subpopulations. In an activated endothelial cell model, RBC adhesion to endothelium and secretion of endothelial activation markers were assessed. The impact of RBC biological age was also assessed in a T cell proliferation assay and in a whole blood stimulation assay.Results: After Percoll fractionation, young RBCs contained more reticulocytes compared to old RBCs. Young RBCs associated with lower levels of E-selectin, ICAM-1, and vWF from activated endothelial cells compared to old RBCs. RBC subpopulations did not affect T cell proliferation or cytokine responses following whole blood stimulation.Conclusion: Young RBCs contain more reticulocytes which are associated with lower levels of endothelial activation markers compared to old RBCs.
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Affiliation(s)
- Abdulrahman Alshalani
- Chair of Medical and Molecular Genetics Research, Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Laboratory of Experimental Intensive Care and Anesthesiology, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Abdulrahman Alshalani,
| | - Boukje M. Beuger
- Department of Molecular Hematology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Anita M. Tuip-de Boer
- Laboratory of Experimental Intensive Care and Anesthesiology, University of Amsterdam, Amsterdam, Netherlands
| | - Robin van Bruggen
- Department of Molecular Hematology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jason P. Acker
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
- Innovation and Portfolio Management, Canadian Blood Services, Edmonton, AB, Canada
| | - Nicole P. Juffermans
- Laboratory of Experimental Intensive Care and Anesthesiology, University of Amsterdam, Amsterdam, Netherlands
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, Netherlands
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11
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Gupta V, Patidar GK, Hote M, Mehar R, Dhiman Y, Hazarika A. Association of blood donor's biological characteristics on outcomes of cardiac surgery patients receiving red blood cells transfusion. Transfus Clin Biol 2023; 30:130-136. [PMID: 36191899 DOI: 10.1016/j.tracli.2022.09.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study aimed to assess the association of blood donor variables on the outcome of patients undergoing cardiac surgery. STUDY DESIGN AND METHODS A retrospective observational study was conducted on patients who had cardiac surgery between January 2018 and December 2020. Blood donor characteristics such as age (≤ or >30 years), sex, and body mass index (BMI) (≤ or >25 kg/m2) were analyzed for association with patient outcomes (length of hospital stay (LOS), mortality, and readmission). Sex matching was done as fully match, fully mismatch, and partial mismatch. Cox regression and Linear regression models were used to study the association with mortality and readmission, and LOS. RESULTS During the study period, 5788 patients had cardiac surgery; receiving a total of 20,348 red cell units. Of which, 522 (9%) died, 531 (9.2%) re-admitted and median LOS was 11 days (IQR 7-18). BMI >25 kg/m2 (β, 2.96; p = 0.000), female to male transfusion (partial mismatch: β, 4.42; p = 0.001; fully mismatch: β, 9.0; p = 0.02) negatively affected LOS. BMI >25 kg/m2 (HR, 2.07; p = 0.00) and partial mismatch transfusion to male patients (HR, 1.60; p = 0.01) increased mortality. Fully mismatch transfusion to female patients (HR, 1.24; p = 0.01) and partial mismatch to male patients (HR, 1.86; p = 0.01) increased readmission. No association of donor age on patient outcome was observed. DISCUSSION Blood donor sex, and BMI can influence mortality and LOS in cardiac surgery patients. The use of computer tools to match the patient's and donor's characteristics can assist to eliminate these types of adverse consequences.
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Affiliation(s)
- Vidushi Gupta
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gopal K Patidar
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Milind Hote
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Radheshyam Mehar
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Yashaswi Dhiman
- Department of Immunohematology & Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Jollygrant, Uttarakhand, India
| | - Anjali Hazarika
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India; CMO (SAG), Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
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12
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Amico F, Efird JT, Briggs GD, Lott NJ, King KL, Hirani R, Balogh ZJ. Association Between Blood Donor Demographics and Post-injury Multiple Organ Failure after Polytrauma. Ann Surg 2023; 277:e170-e174. [PMID: 33491976 PMCID: PMC9762716 DOI: 10.1097/sla.0000000000004754] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test the hypothesis that blood donor demographics are associated with transfused polytrauma patients' post-injury multiple organ failure (MOF) status. SUMMARY OF BACKGROUND DATA Traumatic shock and MOF are preventable causes of death and post-traumatic hemorrhage is a frequent indication for transfusion. The role of blood donor demographics on transfusion recipients is not well known. METHODS A log-linear analysis accounting for the correlated structure of the data based on our prospective MOF database was utilized. Tests for trend and interaction were computed using a likelihood ratio procedure. RESULTS A total of 229 critically injured transfused trauma patients were included, with 68% of them being males and a mean age of 45 years. On average 10 units of blood components were transfused per patient. A total of 4379 units of blood components were donated by donors aged 46 years on average, 74% of whom were males. Blood components used were red blood cells (47%), cryoprecipitate (29%), fresh frozen plasma (24%), and platelets (less than 1%). Donor-recipient sex mismatched red blood cells transfusions were more likely to be associated with MOF ( P = 0.0012); fresh frozen plasma and cryoprecipitate recipients were more likely to experience MOF when transfused with a male (vs female) component ( P = 0.0014 and <0.0001, respectively). Donor age was not significantly associated with MOF for all blood components. CONCLUSIONS Blood components donor sex, but not age, may be an important factor associated with post-injury MOF. Further validation of our findings will help guide future risk mitigation strategies specific to blood donor demographics.
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Affiliation(s)
- Francesco Amico
- Department of Traumatology, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Jimmy T Efird
- Center for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, New South Wales, Australia
| | - Gabrielle D Briggs
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Natalie J Lott
- Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Kate L King
- Department of Traumatology, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Rena Hirani
- Research and Development, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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13
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Red Blood Cell Donor Sex Associated Effects on Morbidity and Mortality in the Extremely Preterm Newborn. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121980. [PMID: 36553422 PMCID: PMC9777093 DOI: 10.3390/children9121980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Transfusion exposure increases the risk of death in critically ill patients of all ages. This was thought to relate to co-morbidities in the transfusion recipient. However, donor characteristics are increasingly recognised as critical to transfusion recipient outcome with systematic reviews suggesting blood donor sex influences transfusion recipient health. Originally focusing on plasma and platelet transfusions, retrospective studies report greater risks of adverse outcomes such as transfusion related acute lung injury in those receiving products from female donors. There is increasing awareness that exposure to red blood cells (RBCs) poses a similar risk. Recent studies focusing on transfusion related outcomes in extremely preterm newborns report conflicting data on the association between blood donor sex and outcomes. Despite a renewed focus on lower versus higher transfusion thresholds in neonatal clinical practice, this group remain a heavily transfused population, receiving on average 3-5 RBC transfusions during their primary hospital admission. Therefore, evidence supporting a role for better donor selection could have a significant impact on clinical outcomes in this high-risk population. Here, we review the emerging evidence for an association between blood donor sex and clinical outcomes in extremely preterm newborns receiving one or more transfusions.
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14
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Is donor-recipient sex associated with transfusion-related outcomes in critically ill patients? Blood Adv 2022; 6:6076-6077. [PMID: 36103149 PMCID: PMC9720514 DOI: 10.1182/bloodadvances.2022008432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/26/2022] [Indexed: 12/14/2022] Open
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15
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Garraud O, Chiaroni J. An overview of red blood cell and platelet alloimmunisation in transfusion. Transfus Clin Biol 2022; 29:297-306. [PMID: 35970488 DOI: 10.1016/j.tracli.2022.08.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Post-transfusion alloimmunisation is the main complication of all those observed after one or more transfusion episodes. Alloimmunisation is observed after the transfusion of red blood cell concentrates but also of platelet concentrates. Besides alloimmunisation due to antigens carried almost exclusively by red blood cells such as those of the Rhesus-Kell system, alloimmunisation often raises against HLA antigens; the main responsibility for that, apart from platelet transfusions, lies with residual leukocytes in the products transfused, hence the central importance of effective leukoreduction right from the blood product preparation stage. Alloimmunization is not restricted to transfusion, but it is also observed during pregnancies, carrying out microtransfusions of blood from the fetus immunizing the mother through the placenta (in a retrograde way). Preexisting maternal-fetal immunization can complicate a transfusion program and intensify the creation of alloantibodies in several blood and tissue group systems. The occurrence of autoantibodies, created by several pathogenic reasons, can also interfere with the propensity of certain recipients of blood components to produce alloantibodies. The genetic condition of individuals is in fact strongly linked to the ability or not to recognize antigenic variants foreign to their own biological program and mount an alloimmune response. Some hemoglobin diseases, in carriers of which transfusions can be iterative and lifelong, are complicated by frequent alloimmunizations and amplification of the complications of these alloimmunizations, imposing even stricter transfusion rules. This review details the mechanisms favoring the occurrence of alloimmunization and the immunological principles for the production of molecular and cellular tools for alloimmunization. It concludes with the main preventive measures available to limit the occurrence of these frequent complications of varying severity but sometimes severe.
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Affiliation(s)
- Olivier Garraud
- Sainbiose-Inserm_U1059, Faculty of Medicine, University of Saint-Etienne, Saint-Etienne, France.
| | - Jacques Chiaroni
- Etablissement Français du Sang Provence-Alpes-Côte d'Azur-Corse, 13005 Marseille, France; Biologie des Groupes Sanguins, EFS, CNRS, ADES, Aix Marseille University, 13005 Marseille, France
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16
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Zhao J, Sjölander A, Edgren G. Mortality Among Patients Undergoing Blood Transfusion in Relation to Donor Sex and Parity: A Natural Experiment. JAMA Intern Med 2022; 182:747-756. [PMID: 35696128 PMCID: PMC9194724 DOI: 10.1001/jamainternmed.2022.2115] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/21/2022] [Indexed: 11/26/2022]
Abstract
Importance Prior evidence suggests that plasma and platelet transfusions from female and parous donors are associated with adverse clinical outcomes, which has led to the predominant use of male donors for plasma and platelets in many countries. However, studies on red blood cell transfusions have been conflicting. Objective To determine whether blood donor sex and parity affect mortality of patients undergoing transfusion with red blood cells. Design, Setting, and Participants This cohort study used nationwide blood bank and health register data in Sweden and involved a natural experiment created by donor sex and parity being concealed and randomly allocated. Patients were included if they were 18 to 90 years old, did not have a history of blood transfusion, and received a transfusion between January 1, 2010, and December 31, 2017. Patients were followed up from their first red blood cell transfusion until death, emigration, or end of study (June 30, 2018). Data analysis was performed between June 15 and December 15, 2021. Exposures (1) Female vs male donors and (2) parous or nonparous female vs male donors. Main Outcomes and Measures Overall survival up to 2 years estimated using inverse probability-weighted Kaplan-Meier estimates and relative risk for additional transfusions within 24 hours. Results Among the 368 778 included patients (mean [SD] age, 66.3 [17.7] years; 57.3% female), 2-year survival differences comparing red blood cell transfusions from female and parous donors to male donors were -0.1% (95% CI, -1.3% to 1.1%) and 0.3% (95% CI, -0.6% to 1.2%), respectively. No statistically significant survival differences were observed regardless of patient sex or age. Median (IQR) hemoglobin counts for female donors (13.5 [13.0-14.0] g/dL) were lower than for male donors (14.9 [14.4-15.5] g/dL). Red blood cell transfusions from female donors were associated with a relative risk of 1.12 (95% CI, 1.08-1.17) for additional transfusions within 24 hours but not after adjusting for donor hemoglobin counts (relative risk, 1.03; 95% CI, 0.98-1.08). Pretransfusion patient characteristics were naturally distributed as-if randomized. Conclusions and Relevance In this nationwide cohort study involving a natural experiment, after accounting for the lower hemoglobin values in blood from female donors, patients undergoing transfusion with blood from female or parous donors did not have higher 2-year mortality compared with recipients of blood from male donors.
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Affiliation(s)
- Jingcheng Zhao
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gustaf Edgren
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
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17
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Vourc’h M, Roquilly A, Foucher A, Retiere C, Feuillet F, Devi S, McWilliam HE, Braudeau C, Bourreille G, Hachani A, O’Kane D, Mueller SN, Ischia J, Roussel JC, Rigal JC, Josien R, Rozec B, Villadangos JA, Asehnoune K. Transfusion-Related Renal Dysfunction After Cardiac Surgery. JACC Basic Transl Sci 2022; 7:627-638. [PMID: 35958696 PMCID: PMC9357562 DOI: 10.1016/j.jacbts.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/25/2022]
Abstract
Following cardiac surgery, 20% of patients will present with AKI, which is associated with increased mortality, and transfusion increases the risk of AKI. The main objective was to determine whether the composition of transfusion was associated with AKI. In this study, AKI patients received higher amount of MRP_14 through transfusion vs non-AKI. MRP_14 has been reported to activate and enhance neutrophil transmigration into damaged tissues. In a murine model of ischemia-reperfusion, MRP_14 increased renal damage and enhanced neutrophil influx into the kidney. MRP_14 also increased neutrophilic-trogocytosis toward tubular cells. The sex of the donor and the method of preparation of the blood determined the concentration of MRP_14 in packed red blood cells.
Transfusion is a specific cause of acute kidney injury (AKI) after cardiac surgery. Whether there is an association between the composition of blood products and the onset of AKI is unknown. The present study suggests that the transfusion of packed red blood cells containing a high amount of myeloid-related protein 14 (MRP_14) could increase the incidence of AKI after cardiac surgery. In a mouse model, MRP_14 increased the influx of neutrophils in the kidney after ischemia-reperfusion and their ability to damage tubular cells. Higher concentrations of MRP_14 were found in packed red blood cells from female donors or prepared by whole blood filtration.
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Alshalani A, van Manen L, Boshuizen M, van Bruggen R, Acker JP, Juffermans NP. The Effect of Sex-Mismatched Red Blood Cell Transfusion on Endothelial Cell Activation in Critically Ill Patients. Transfus Med Hemother 2022; 49:98-105. [PMID: 35611381 PMCID: PMC9082204 DOI: 10.1159/000520651] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/30/2021] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Observational studies suggest that sex-mismatched transfusion is associated with increased mortality. Mechanisms driving mortality are not known but may include endothelial activation. The aim of this study is to investigate the effects of sex-mismatched red blood cell (RBC) transfusions on endothelial cell activation markers in critically ill patients. STUDY DESIGN AND METHODS In patients admitted to the intensive care unit who received a single RBC unit, blood samples were drawn before (T0), 1 h after (T1), and 24 h after transfusion (T24) for analysis of soluble syndecan-1, soluble intercellular adhesion molecule-1, soluble thrombomodulin (sTM), von Willebrand factor antigen, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNFα). Changes in the levels of these factors were compared between sex-matched and sex-mismatched groups. RESULTS Of 69 included patients, 32 patients were in the sex-matched and 37 patients were in the sex-mismatched group. Compared to baseline, sex-matched transfusion was associated with significant reduction in sTM level (p value = 0.03). Between-group comparison showed that levels of syndecan-1 and sTM were significantly higher in the sex-mismatched group compared to the sex-matched group at T24 (p value = 0.04 and 0.01, respectively). Also, TNFα and IL-6 levels showed a statistically marginal significant increase compared to baseline in the sex-mismatched group at T24 (p value = 0.06 and 0.05, respectively), but not in the sex-matched group. DISCUSSION Transfusion of a single sex-mismatched RBC unit was associated with higher syndecan-1 and sTM levels compared to transfusion of sex-matched RBC unit. These findings may suggest that sex-mismatched RBC transfusion is associated with endothelial activation.
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Affiliation(s)
- Abdulrahman Alshalani
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Clinical Laboratory Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Lisa van Manen
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Margit Boshuizen
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Robin van Bruggen
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jason P. Acker
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Centre for Innovation, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Nicole P. Juffermans
- Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Intensive Care, OLVG Hospital, Amsterdam, The Netherlands
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19
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Nemkov T, Yoshida T, Nikulina M, D’Alessandro A. High-Throughput Metabolomics Platform for the Rapid Data-Driven Development of Novel Additive Solutions for Blood Storage. Front Physiol 2022; 13:833242. [PMID: 35360223 PMCID: PMC8964052 DOI: 10.3389/fphys.2022.833242] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/23/2022] [Indexed: 02/04/2023] Open
Abstract
Red blood cell transfusion is a life-saving intervention, and storage is a logistic necessity to make ~110 million units available for transfusion every year worldwide. However, storage in the blood bank is associated with a progressive metabolic decline, which correlates with the accumulation of morphological lesions, increased intra- and extra-vascular hemolysis upon transfusion, and altered oxygen binding/off-loading kinetics. Prior to storage, red blood cells are suspended in nutrient formulations known as additive solutions to prolong cellular viability. Despite a thorough expansion of knowledge regarding red blood cell biology over the past few decades, only a single new additive solution has been approved by the Food and Drug Administration this century, owing in part to the limited capacity for development of novel formulations. As a proof of principle, we leveraged a novel high-throughput metabolomics technology as a platform for rapid data-driven development and screening of novel additive solutions for blood storage under both normoxic and hypoxic conditions. To this end, we obtained leukocyte-filtered red blood cells (RBCs) and stored them under normoxic or hypoxic conditions in 96 well plates (containing polyvinylchloride plasticized with diethylhexylphthalate to concentrations comparable to full size storage units) in the presence of an additive solution supplemented with six different compounds. To inform this data-driven strategy, we relied on previously identified metabolic markers of the RBC storage lesion that associates with measures of hemolysis and post-transfusion recovery, which are the FDA gold standards to predict stored blood quality, as well as and metabolic predictors of oxygen binding/off-loading parameters. Direct quantitation of these predictors of RBC storage quality were used here-along with detailed pathway analysis of central energy and redox metabolism-as a decision-making tool to screen novel additive formulations in a multiplexed fashion. Candidate supplements are shown here that boost-specific pathways. These metabolic effects are only in part dependent on the SO2 storage conditions. Through this platform, we anticipate testing thousands of novel additives and combinations thereof in the upcoming months.
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Affiliation(s)
- Travis Nemkov
- Omix Technologies Inc., Denver, CO, United States
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver – Anschutz Medical Campus, Aurora, CO, United States
| | | | | | - Angelo D’Alessandro
- Omix Technologies Inc., Denver, CO, United States
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver – Anschutz Medical Campus, Aurora, CO, United States
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20
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Donor-recipient sex is associated with transfusion-related outcomes in critically ill patients. Blood Adv 2022; 6:3260-3267. [PMID: 35286383 PMCID: PMC9198942 DOI: 10.1182/bloodadvances.2021006402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/06/2022] [Indexed: 11/20/2022] Open
Abstract
Transfusion of female RBCs to male recipients increases the risk of ICU mortality compared with female blood to female recipients. Receiving RBCs from female donors is associated with a trend toward ARDS.
Transfusion of red blood cells (RBCs) from female donors has been associated with increased risk of mortality. This study aims to investigate the associations between donor-recipient sex and posttransfusion 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 intensive care unit (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 with transfusion of female RBCs to female patients (odds ratio, 2.43; 95% confidence interval, 1.02-5.77; P < .05). There was a trend toward increased ARDS in patients receiving RBC from female donors compared with those receiving blood from males (P = .06), whereas AKI was higher in donor-recipient sex-matched transfusion groups compared with sex-mismatched groups (P = .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.
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21
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Patel RM, Lukemire J, Shenvi N, Arthur C, Stowell SR, Sola-Visner M, Easley K, Roback JD, Guo Y, Josephson CD. Association of Blood Donor Sex and Age With Outcomes in Very Low-Birth-Weight Infants Receiving Blood Transfusion. JAMA Netw Open 2021; 4:e2123942. [PMID: 34477851 PMCID: PMC8417762 DOI: 10.1001/jamanetworkopen.2021.23942] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE There are conflicting data on the association between blood donor characteristics and outcomes among patients receiving transfusions. OBJECTIVE To evaluate the association of blood donor sex and age with mortality or serious morbidity in very low-birth-weight (VLBW) infants receiving blood transfusions. DESIGN, SETTING, AND PARTICIPANTS This is a cohort study using data collected from 3 hospitals in Atlanta, Georgia. VLBW infants (≤1500 g) who received red blood cell (RBC) transfusion from exclusively male or female donors were enrolled from January 2010 to February 2014. Infants received follow-up until 90 days, hospital discharge, transfer to a non-study-affiliated hospital, or death. Data analysis was performed from July 2019 to December 2020. EXPOSURES Donor sex and mean donor age. MAIN OUTCOMES AND MEASURES The primary outcome was a composite outcome of death, necrotizing enterocolitis (Bell stage II or higher), retinopathy of prematurity (stage III or higher), or moderate-to-severe bronchopulmonary dysplasia. Modified Poisson regression, with consideration of covariate interactions, was used to estimate the association between donor sex and age with the primary outcome, with adjustment for the total number of transfusions and birth weight. RESULTS In total, 181 infants were evaluated, with a mean (SD) birth weight of 919 (253) g and mean (SD) gestational age of 27.0 (2.2) weeks; 56 infants (31%) received RBC transfusion from exclusively female donors. The mean (SD) donor age was 46.6 (13.7) years. The primary outcome incidence was 21% (12 of 56 infants) among infants receiving RBCs from exclusively female donors, compared with 45% (56 of 125 infants) among those receiving RBCs from exclusively male donors. Significant interactions were detected between female donor and donor age (P for interaction = .005) and between female donor and number of transfusions (P for interaction < .001). For the typical infant, who received a median (interquartile range) of 2 (1-3) transfusions, RBC transfusion from exclusively female donors, compared with male donors, was associated with a lower risk of the primary outcome (relative risk, 0.29; 95% CI, 0.16-0.54). The protective association between RBC transfusions from female donors, compared with male donors, and the primary outcome increased as the donor age increased, but decreased as the number of transfusions increased. CONCLUSIONS AND RELEVANCE These findings suggest that RBC transfusion from female donors, particularly older female donors, is associated with a lower risk of death or serious morbidity in VLBW infants receiving transfusion. Larger studies confirming these findings and examining potential mechanisms are warranted.
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Affiliation(s)
- Ravi M. Patel
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Joshua Lukemire
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Neeta Shenvi
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Connie Arthur
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
- Center for Transfusion and Cellular Therapies, Emory University, Atlanta, Georgia
| | - Sean R. Stowell
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
- Center for Transfusion and Cellular Therapies, Emory University, Atlanta, Georgia
- Joint Program in Transfusion Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Martha Sola-Visner
- Division of Newborn Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kirk Easley
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - John D. Roback
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
- Center for Transfusion and Cellular Therapies, Emory University, Atlanta, Georgia
| | - Ying Guo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Cassandra D. Josephson
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
- Center for Transfusion and Cellular Therapies, Emory University, Atlanta, Georgia
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22
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Längst E, Tissot JD, Prudent M. Storage of red blood cell concentrates: Clinical impact. Transfus Clin Biol 2021; 28:397-402. [PMID: 34464712 DOI: 10.1016/j.tracli.2021.08.344] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/25/2021] [Indexed: 01/11/2023]
Abstract
The storage of red blood cells for transfusion purposes induces modifications of biochemical and biological properties. Moreover, these modifications are modulated by the donors' characteristics and the cell processing. These ex vivo alterations were suspected to decrease the transfusion efficiency and even to induce adverse events. This short article will review the red blood cells storage lesions and the clinical data related to them. In particular, the questions regarding the donors and recipients sex will be discussed.
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Affiliation(s)
- E Längst
- Laboratoire de Recherche sur les Produits Sanguins, Transfusion Interrégionale CRS, Épalinges, Switzerland; Faculté de Biologie et de Médecine, université de Lausanne, Lausanne, Switzerland
| | - J-D Tissot
- Faculté de Biologie et de Médecine, université de Lausanne, Lausanne, Switzerland
| | - M Prudent
- Laboratoire de Recherche sur les Produits Sanguins, Transfusion Interrégionale CRS, Épalinges, Switzerland; Faculté de Biologie et de Médecine, université de Lausanne, Lausanne, Switzerland; Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University Hospital and University of Lausanne, Lausanne, Switzerland.
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23
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Current Understanding of the Relationship between Blood Donor Variability and Blood Component Quality. Int J Mol Sci 2021; 22:ijms22083943. [PMID: 33920459 PMCID: PMC8069744 DOI: 10.3390/ijms22083943] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/19/2022] Open
Abstract
While differences among donors has long challenged meeting quality standards for the production of blood components for transfusion, only recently has the molecular basis for many of these differences become understood. This review article will examine our current understanding of the molecular differences that impact the quality of red blood cells (RBC), platelets, and plasma components. Factors affecting RBC quality include cytoskeletal elements and membrane proteins associated with the oxidative response as well as known enzyme polymorphisms and hemoglobin variants. Donor age and health status may also be important. Platelet quality is impacted by variables that are less well understood, but that include platelet storage sensitive metabolic parameters, responsiveness to agonists accumulating in storage containers and factors affecting the maintenance of pH. An increased understanding of these variables can be used to improve the quality of blood components for transfusion by using donor management algorithms based on a donors individual molecular and genetic profile.
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Fergusson DA, Chassé M, Tinmouth A, Acker JP, English S, Forster AJ, Hawken S, Shehata N, Thavorn K, Wilson K, Tuttle A, Perelman I, Cober N, Maddison H, Tokessy M. Pragmatic, double-blind, randomised trial evaluating the impact of red blood cell donor sex on recipient mortality in an academic hospital population: the innovative Trial Assessing Donor Sex (iTADS) protocol. BMJ Open 2021; 11:e049598. [PMID: 33622960 PMCID: PMC7907852 DOI: 10.1136/bmjopen-2021-049598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION With over 1 million units of blood transfused each year in Canada, their use has a significant clinical and economic impact on our health system. Adequate screening of blood donors is important to ensure the safety and clinical benefit of blood products. Some adverse transfusion reactions have been shown to be related to donor factors (eg, lung injury), whereas other adverse outcomes have been theoretically related to donor factors (mortality and infection). Our clinical trial will test whether male donor blood leads to a greater benefit for transfusion recipients compared with female donor blood. METHODS AND ANALYSIS We have designed a pragmatic, double-blind, randomised trial that will allocate transfusion recipients to receive either male-only or female-only donor transfusions. We will enrol 8850 adult patients requiring at least one transfusion at four sites over an approximate 2-year period. Randomisation and allocation will occur in the blood bank prior to release of the units of blood for transfusion. Our primary outcome is mortality. An intent-to-treat analysis will be applied using all randomised and transfused patients. The principal analysis will be a survival analysis comparing the time from randomisation to death between patients allocated to male donor red blood cells (RBCs) and female donor RBCs. ETHICS AND DISSEMINATION Approval has been obtained from research ethics boards of all involved institutions, as well as from privacy offices of Canadian Blood Services, Institute for Clinical Evaluative Science and The Ottawa Hospital Data Warehouse. Our findings will be published in peer-reviewed journals and presented at relevant stakeholder conferences and meetings. TRIAL REGISTRATION NUMBER NCT03344887; Pre-results.
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Affiliation(s)
- Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Chassé
- Department of Medicine, Division of Critical Care, University of Montreal, Montreal, Quebec, Canada
| | - Alan Tinmouth
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Hematology, Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jason P Acker
- Center for Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Shane English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Alan J Forster
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Internal Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Steven Hawken
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Nadine Shehata
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Angie Tuttle
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Iris Perelman
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Nancy Cober
- Eastern Ontario Regional Laboratory Association, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Heather Maddison
- Eastern Ontario Regional Laboratory Association, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Melanie Tokessy
- Eastern Ontario Regional Laboratory Association, Ottawa Hospital, Ottawa, Ontario, Canada
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25
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Save it-don't waste it! Maximizing utilization of erythrocytes from previously stored whole blood. J Trauma Acute Care Surg 2020; 89:665-672. [PMID: 32590560 DOI: 10.1097/ta.0000000000002839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Recent military and civilian experience suggests that fresh whole blood may be the preferred for treatment of hemorrhagic shock, but its use is limited by its 21-day shelf life. The red blood cell storage lesion and coagulation status of packed red blood cells (pRBCs) salvaged from expired whole blood are unknown. We hypothesized that pRBCs can be salvaged from previously stored whole blood. METHODS Cold stored, low-titer, O-positive, nonleukoreduced, whole blood units were obtained at 21 days of storage. Erythrocytes were separated by centrifugation, resuspended in AS-3, and stored for 21 additional days as salvaged pRBCs. The red blood cell storage lesion parameters of microvesicles, Band-3, free hemoglobin, annexin V, and erythrocyte osmotic fragility were measured and compared with pRBCs prepared at the time of donation and stored in AS-3 for 42 days (standard pRBCs). In additional experiments, murine pRBCs were prepared from expired whole blood units and compared with those stored under standard conditions. Mice underwent hemorrhage and resuscitation with standard and salvaged pRBC units, and serum cytokines and free hemoglobin were determined. RESULTS There were no significant differences in microvesicle formation or cell-free hemoglobin concentration between salvaged and standard pRBCs. There was decreased Band-3 and increased phosphatidylserine in the salvaged units as well as greater osmotic fragility. Salvaged pRBCs maintained consistent clot firmness. After hemorrhage and resuscitation in a murine model, salvaged pRBCs did not demonstrate increased serum cytokine levels. CONCLUSION Salvaged pRBCs from previously stored whole blood accumulate the red blood cell storage lesion in a similar fashion to standard pRBCs and maintain consistent coagulability when reconstituted with plasma. Salvaged pRBCs are not associated with an increased inflammatory response when used for resuscitation in a murine model. Salvaged pRBCs may be a viable product for utilization in the treatment of traumatic hemorrhagic shock.
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Juffermans NP, Aubron C, Duranteau J, Vlaar APJ, Kor DJ, Muszynski JA, Spinella PC, Vincent JL. Transfusion in the mechanically ventilated patient. Intensive Care Med 2020; 46:2450-2457. [PMID: 33180167 PMCID: PMC7658306 DOI: 10.1007/s00134-020-06303-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/16/2020] [Indexed: 12/20/2022]
Abstract
Red blood cell transfusions are a frequent intervention in critically ill patients, including in those who are receiving mechanical ventilation. Both these interventions can impact negatively on lung function with risks of transfusion-related acute lung injury (TRALI) and other forms of acute respiratory distress syndrome (ARDS). The interactions between transfusion, mechanical ventilation, TRALI and ARDS are complex and other patient-related (e.g., presence of sepsis or shock, disease severity, and hypervolemia) or blood product-related (e.g., presence of antibodies or biologically active mediators) factors also play a role. We propose several strategies targeted at these factors that may help limit the risks of associated lung injury in critically ill patients being considered for transfusion.
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Affiliation(s)
- Nicole P Juffermans
- Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centre, Location Academic Medical Centre, Amsterdam, The Netherlands
- Department of Intensive Care, OLVG Hospital, Amsterdam, The Netherlands
| | - Cécile Aubron
- Medical Intensive Care, Brest University Hospital, Université de Bretagne Occidentale, Brest, France
| | - Jacques Duranteau
- Department of Anesthesiology and Critical Care, Bicêtre, Hôpitaux Universitaires Paris Saclay, Université Paris Saclay, AP-HP, Le Kremlin Bicêtre, France
| | - Alexander P J Vlaar
- Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam University Medical Centre, Location Academic Medical Centre, Amsterdam, The Netherlands
- Department of Intensive Care, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Daryl J Kor
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jennifer A Muszynski
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus, OH, USA
| | - Philip C Spinella
- Department of Pediatrics, Division of Critical Care Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
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Zeng X, Liao Y, Wu X, Xu J, Da C, Tan Z, Feng F, Yin W, Wang D, Hu X. Association between recipient survival and blood donor age after blood transfusion in a surgery intensive care unit: a multicenter randomized controlled trial study protocol. Trials 2020; 21:621. [PMID: 32641079 PMCID: PMC7341644 DOI: 10.1186/s13063-020-04452-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 05/24/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Blood from younger individuals has been shown to improve physiological function in recipients in laboratory research, and many proteins from human peripheral blood show antisenescence capabilities. Thus, researchers have questioned whether blood from young donors is superior to blood from older donors. Blood transfusion is a key supportive therapy for trauma patients, and recent studies have reported the influence of blood donor age on recipient patient prognosis. Although some retrospective results found that blood from young donors improves survival, no influence of blood donor age was observed on outcomes in other study groups. The reasons for this discrepancy are complicated, but the fact that data were not obtained from randomized controlled trial (RCT) data should be considered. The current protocol and analysis method provide a feasible RCT design to evaluate the prognosis of severely ill surgery patients who were transfused with blood products from blood donors of different ages. METHODS The current study is a pragmatic multicenter RCT (open, parallel-group, non-masked, superiority trial). Recruited surgery intensive care unit patients will be randomized into three groups and transfused with blood products from male donors of different ages (< 25, 25-45, and > 45 years). Survival time will be measured within 28 days. The survival characteristics, possible interaction between variables, and potential factors associated with death will be analyzed by Kaplan-Meier analysis, two-way ANOVA, and Cox proportional hazards model, respectively. TRIAL REGISTRATION ChiCTR: ChiCTR190002. Registered on 22 March 2019. http://www.chictr.org.cn/showproj.aspx?proj=36867 .
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Affiliation(s)
- Xianfei Zeng
- School of Medicine, Northwest University, Xi'an, 710069, China.,The National Engineering Research Center for Miniaturized Detection Systems, College of Life Science, Northwest University, Xi'an, 710069, China.,Department of Transfusion Medicine, Shaanxi Corps Hospital, Chinese People's Armed Police Forces, Xi'an, 710054, China
| | - Yan Liao
- Department of Transfusion Medicine, Third Affiliated Hospital of Guangxi Medical University, Nanning, 530031, China
| | - Xiaoshuang Wu
- Department of Transfusion Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
| | - Jinmei Xu
- Department of Transfusion Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
| | - Chenxing Da
- Department of Endocrinology, Shaanxi Corps Hospital, Chinese People's Armed Police Forces, Xi'an, 710054, China
| | - Zhijun Tan
- Department of Statistics, Fourth Military Medical University, Xi'an, 710032, China
| | - Fan Feng
- Department of Digestive Surgery, Xijing Hospital, Xi'an, 710032, China
| | - Wen Yin
- Department of Transfusion Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
| | - Dongjian Wang
- Department of Transfusion Medicine, 908th Hospital of PLA, Yingtan, 335000, China.
| | - Xingbin Hu
- Department of Transfusion Medicine, Xijing Hospital, The Fourth Military Medical University, Xi'an, 710032, China.
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28
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Roubinian NH, Kanias T. Blood donor component-recipient linkages: is there fire where there is smoke? Transfusion 2020; 59:2485-2488. [PMID: 31374151 DOI: 10.1111/trf.15450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Nareg H Roubinian
- Kaiser Permanente Northern California Division of Research, Oakland, California.,Vitalant Research Institute, San Francisco, California.,University of California, San Francisco, San Francisco, California
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29
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Malfait T, Emonds MP, Daniëls L, Nagler EV, Van Biesen W, Van Laecke S. HLA Class II Antibodies at the Time of Kidney Transplantation and Cardiovascular Outcome: A Retrospective Cohort Study. Transplantation 2020; 104:823-834. [DOI: 10.1097/tp.0000000000002889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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30
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Gupta N, Khetan D, Chaudhary R, Shukla JS. Prospective Cohort Study to Assess the Effect of Storage Duration, Leuko-Filtration, and Gamma Irradiation on Cell-Free DNA in Red Cell Components. Transfus Med Hemother 2020; 47:409-419. [PMID: 33173459 DOI: 10.1159/000505937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/10/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Damage to a cell and the loss of integrity of its cell membrane leads to the release of endogenous immunogenic molecules, which together are classified as "damage-associated molecular patterns" (DAMPs). Cell-free DNA (cf-DNA) released from nucleosomes may serve as a proco-agulant cofactor and may be an important mediator of immunomodulatory and proinflammatory effects associated with blood transfusion. Objectives To assess the levels of cf-DNA in supernatants of stored red cell components and the effect of leukoreduction and gamma irradiation on the release of cf-DNA during storage. Methods This is a prospective cohort study on 99 stored red cell components, randomly divided into three groups - buffy coat (BC)-depleted, leuko-filtered (LP), and irradiated (IR) packed red blood cells. Red cell supernatants were drawn over a period of 21 days at three different time points (day 0, 7, and 21) from the study units. cf-DNA extraction was done and quantified by a bench top fluorometer. Change in cf-DNA content, rate of change (μg/day), and percent change were estimated and compared across different groups. Results cf-DNA content increased (p = 0.000) with storage duration in the BC (median = 238.66 μg, interquartile range [IQR] = 168.42 on day 21 vs. median = 9.44 μg, IQR = 5.23 on day 0) and IR groups (p = 0.000) (median = 245.55 μg, IQR = 253.88 on day 21 vs. median = 7.07 μg, IQR = 13.58 on day 0), while there was a decreasing trend (p = 0.032) in the LP group (median = 4.55 μg, IQR = 10.73 on day 21 vs. median = 8.66 μg, IQR = 6.56 on day 0). The median rate of change in cf-DNA content (11.13 μg/day) and percent change in cf-DNA content (median = 4,106.16%) was highest in the IR group. Conclusions Stored red cell components contain significant amount of cf-DNA. Release of cf-DNA is further aggravated by irradiation while leukoreduction leads to a decrease in cf-DNA content.
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Affiliation(s)
- Nitesh Gupta
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Dheeraj Khetan
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajendra Chaudhary
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Jai Shankar Shukla
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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31
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Fresh Low Titer O Whole Blood Transfusion in the Austere Medical Environment. Wilderness Environ Med 2019; 30:425-430. [PMID: 31694782 DOI: 10.1016/j.wem.2019.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/06/2019] [Accepted: 08/13/2019] [Indexed: 11/23/2022]
Abstract
Massive hemorrhage is an immediate threat to life. The military developed the Tactical Combat Casualty Care guidelines to address the management of acute trauma, including administration of blood products. The guidelines have been expanded to include low titer O whole blood, which is in limited use by the military. This proposal describes how the transfusion of fresh whole blood might be applied to the remote civilian environment. In doing so, this life-saving intervention may be brought to the austere medical environment, allowing critically hemorrhaging patients to survive to reach definitive medical care.
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32
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Roubinian NH, Westlake M, St Lezin EM, Edgren G, Brambilla DJ, Lee C, Bruhn R, Cable RG, Triulzi DJ, Glynn SA, Kleinman S, Murphy EL. Association of donor age, body mass index, hemoglobin, and smoking status with in-hospital mortality and length of stay among red blood cell-transfused recipients. Transfusion 2019; 59:3362-3370. [PMID: 31602669 DOI: 10.1111/trf.15541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/23/2019] [Accepted: 08/24/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent publications have reported conflicting findings regarding associations of blood donor demographics and mortality of transfused patients. We hypothesized that the analysis of additional donor characteristics and consideration of alternative outcomes might provide insight into these disparate results. STUDY DESIGN AND METHODS We analyzed data from a retrospective cohort of transfused patients from the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III). We used stratified Cox regression models to estimate associations between blood donor characteristics and hospital mortality and posttransfusion length of stay among patients transfused red blood cell (RBC) units. Donor characteristics evaluated included age, body mass index, hemoglobin levels, and smoking status. The statistical analyses were adjusted for recipient factors, including total number of transfusions. RESULTS We studied 93,726 patients in 130,381 hospitalizations during which 428,461 RBC units were transfused. There were no associations between blood donor characteristics and hospital mortality. Receipt of RBC units from donors less than 20 years of age was associated with a shorter hospital length of stay (hazard ratio for discharge per transfused unit, 1.03; 95% confidence interval, 1.02-1.04; p < 0.001) but not for other donor characteristics. CONCLUSION We found no evidence of associations between blood donor factors and in-hospital mortality. Our finding of shorter hospital length of stay in patients transfused RBCs from younger donors is intriguing but requires confirmation. Future collaborations are needed to develop a framework of appropriate methodologic approaches to be used in linked analyses across large cohorts.
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Affiliation(s)
- Nareg H Roubinian
- Kaiser Permanente Northern California Division of Research, Oakland, California.,Vitalant Research Institute, San Francisco, California.,Department of Laboratory Medicine, UCSF, San Francisco, California
| | | | - Elizabeth M St Lezin
- Department of Laboratory Medicine, UCSF, San Francisco, California.,Veterans Affairs Healthcare System, San Francisco, California
| | - Gustaf Edgren
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | | | - Catherine Lee
- Kaiser Permanente Northern California Division of Research, Oakland, California
| | - Roberta Bruhn
- Vitalant Research Institute, San Francisco, California
| | - Ritchard G Cable
- American Red Cross Blood Services, Connecticut Region, Farmington, Connecticut
| | | | - Simone A Glynn
- National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | | | - Edward L Murphy
- Vitalant Research Institute, San Francisco, California.,Department of Laboratory Medicine, UCSF, San Francisco, California
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33
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The best blood product and its best use for each patient: An evolving role for hemovigilance? Transfus Clin Biol 2019; 26:188-191. [DOI: 10.1016/j.tracli.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 04/30/2019] [Indexed: 11/20/2022]
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34
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Roubinian N, Kleinman S, Murphy EL, Glynn SA, Edgren G. Methodological considerations for linked blood donor-component-recipient analyses in transfusion medicine research. ACTA ACUST UNITED AC 2019; 15:185-193. [PMID: 32368251 DOI: 10.1111/voxs.12518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
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.
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Affiliation(s)
- Nareg Roubinian
- Kaiser Permanente Northern California Division of Research, Oakland, California.,Vitalant Research Institute, San Francisco, California.,University of California, San Francisco, San Francisco, California
| | | | - Edward L Murphy
- University of California, San Francisco, San Francisco, California.,Vitalant Research Institute, San Francisco, California
| | - Simone A Glynn
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Gustaf Edgren
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Södersjukhuset, Stockholm, Sweden
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35
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Edgren G, Murphy EL, Brambilla DJ, Westlake M, Rostgaard K, Lee C, Cable RG, Triulzi D, Bruhn R, St. Lezin EM, Erikstrup C, Ullum H, Glynn SA, Kleinman S, Hjalgrim H, Roubinian NH. Association of Blood Donor Sex and Prior Pregnancy With Mortality Among Red Blood Cell Transfusion Recipients. JAMA 2019; 321:2183-2192. [PMID: 31184739 PMCID: PMC6563535 DOI: 10.1001/jama.2019.7084] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Evidence regarding associations of blood donor sex with mortality among red blood cell transfusion recipients is conflicting. OBJECTIVE To study associations of donor sex and prior pregnancy with mortality of transfusion recipients. DESIGN, SETTING, AND PARTICIPANTS Data from 3 retrospective cohorts of transfusion recipients (the Kaiser Permanente Northern California [KPNC] and Recipient Epidemiology and Donor Evaluation Study-III [REDS-III] databases of data from January 2013 to December 2016 and the Scandinavian Donations and Transfusions [SCANDAT] database with data from January 2003 to December 2012) were analyzed. Final dates of follow-up were December 31, 2016, for the KPNC and REDS-III cohorts and December 31, 2012, for the SCANDAT cohort. Stratified Cox regression models were used to estimate associations between donor exposure groups with risk of mortality, adjusting for the number of red blood cell unit transfusions. EXPOSURES The number of transfused red blood cell units from female donors, previously pregnant donors, and sex-discordant donors (male donor and female recipient or female donor and male recipient). MAIN OUTCOMES AND MEASURES In-hospital mortality. RESULTS The study population included 34 662 patients (mean age, 69 years; 18 652 [54%] women) from the KPNC cohort, 93 724 patients (mean age, 61 years; 48 348 [52%] women) from the REDS-III cohort, and 918 996 patients (mean age, 72 years; 522 239 [57%] women) from the SCANDAT cohort. The median number of red blood cell transfusions per patient was 3 in the KPNC cohort, 2 in the REDS-III cohort, and 3 in the SCANDAT cohort. The percentage of transfusions from previously pregnant or parous donors was 9% in the KPNC cohort, 18% in the REDS-III cohort, and 25% in the SCANDAT cohort. The percentage of transfusions in the 3 cohorts from female donors ranged from 39% to 43%, from previously pregnant or parous donors ranged from 9% to 25%, and from sex-discordant donors ranged from 44% to 50%. There were 3217 in-hospital deaths in the KPNC cohort, 8519 in the REDS-III cohort, and 198 537 in the SCANDAT cohort. There were no statistically significant associations between any of the 3 donor exposures and in-hospital mortality in the 3 cohorts. Hazard ratios for in-hospital mortality per transfused unit from female donors were 0.99 (95% CI, 0.96-1.03) for the KPNC cohort, 1.00 (95% CI, 0.99-1.01) for the REDS-III cohort, and 1.00 (95% CI, 0.99-1.00) for the SCANDAT cohort. For units from previously pregnant or parous female donors, hazard ratios were 1.00 (95% CI, 1.00-1.01) for the KPNC cohort, 1.01 (95% CI, 0.98-1.03) for the REDS-III cohort, and 1.00 (95% CI, 1.00-1.01) for the SCANDAT cohort. For units from sex-discordant transfusions, hazard ratios were 1.02 (95% CI, 0.99-1.05) for the KPNC cohort, 0.99 (95% CI, 0.98-1.00) for the REDS-III cohort, and 1.00 (95% CI, 0.99-1.00) for the SCANDAT cohort. CONCLUSIONS AND RELEVANCE Among red blood cell transfusion recipients, transfusions from female, previously pregnant, or sex-discordant donors were not significantly associated with increased mortality.
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Affiliation(s)
- Gustaf Edgren
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Edward L. Murphy
- Vitalant Research Institute, San Francisco, California
- Department of Laboratory Medicine, University of California San Francisco
| | | | | | - Klaus Rostgaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland
| | | | - Darrell Triulzi
- Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | - Roberta Bruhn
- Vitalant Research Institute, San Francisco, California
| | - Elizabeth M. St. Lezin
- Department of Laboratory Medicine, University of California San Francisco
- Veterans Affairs Healthcare System, San Francisco, California
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, the Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Simone A. Glynn
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Henrik Hjalgrim
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nareg H. Roubinian
- Vitalant Research Institute, San Francisco, California
- Department of Laboratory Medicine, University of California San Francisco
- Division of Research, Kaiser Permanente Northern California, Oakland
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Alshalani A, Li W, Juffermans NP, Seghatchian J, Acker JP. Biological mechanisms implicated in adverse outcomes of sex mismatched transfusions. Transfus Apher Sci 2019; 58:351-356. [DOI: 10.1016/j.transci.2019.04.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Cohn CS, Allen ES, Cushing MM, Dunbar NM, Friedman DF, Goel R, Harm SK, Heddle N, Hopkins CK, Klapper E, Perumbeti A, Ramsey G, Raval JS, Schwartz J, Shaz BH, Spinella PC, Pagano MB. 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. Transfusion 2019; 59:2733-2748. [PMID: 31148175 DOI: 10.1111/trf.15348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/01/2019] [Accepted: 05/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The AABB compiles an annual synopsis of the published literature covering important developments in the field of transfusion medicine. An abridged version of this work is being made available in TRANSFUSION, with the full-length report available as Appendix S1 (available as supporting information in the online version of this paper). STUDY DESIGN AND METHODS Papers published in late 2017 and 2018 are included, as well as earlier papers cited for background. Although this synopsis is comprehensive, it is not exhaustive, and some papers may have been excluded or missed. 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.
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Affiliation(s)
- Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Elizabeth S Allen
- Department of Pathology, University of California, San Diego, California
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - David F Friedman
- Blood Bank and Transfusion Medicine Department, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ruchika Goel
- Division of Transfusion Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.,Division of Hematology/Oncology, Mississippi Valley Regional Blood Center, Springfield, Illinois
| | - Sarak K Harm
- University of Vermont Medical Center, Burlington, VT
| | - Nancy Heddle
- McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | | | - Ellen Klapper
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ajay Perumbeti
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Glenn Ramsey
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jay S Raval
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico
| | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University, and, New York, New York
| | | | - Philip C Spinella
- Department of Pediatrics, Division of Pediatric Critical Care, Washington University in St Louis School of Medicine, Saint Louis, Missouri
| | - Monica B Pagano
- Transfusion Medicine Division, Department of Laboratory Medicine, University of Washington, Seattle, Washington
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38
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Zeller MP, Rochwerg B, Jamula E, Li N, Hillis C, Acker JP, Runciman RJR, Lane SJ, Ahmed N, Arnold DM, Heddle NM. Sex-mismatched red blood cell transfusions and mortality: A systematic review and meta-analysis. Vox Sang 2019; 114:505-516. [PMID: 31124172 DOI: 10.1111/vox.12783] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/22/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Selection of a compatible red blood cell (RBC) unit does not include matching for donor sex. This systematic review and meta-analysis aims to summarize the evidence examining the impact of sex-mismatched RBC transfusion on recipient mortality. MATERIALS AND METHODS Ovid MEDLINE, Ovid EMBASE, CINAHL, PubMed, Web of Science and the Cochrane Database of Systematic Reviews were searched from inception up to 23 November 2018. Randomized controlled trials and observational studies were included in the search. Eligible studies reported on the impact of sex-matched compared to sex-mismatched RBC transfusion on recipient mortality. Two investigators independently extracted data and assessed study quality. A three-level meta-analytic model was applied to emphasize the unknown dependence among the effect sizes. RESULTS Five retrospective observational studies (n = 86 737) were included; no RCTs were found. Sex-mismatched RBC transfusions were associated with a higher risk of death compared with sex-matched transfusions (pooled hazard ratio [HR]: 1·13; 95% confidence interval [CI]: 1·02-1·24). In the subgroup of cardiovascular surgery (n = 57 712), there was no significant increase in mortality with sex-mismatched transfusions (pooled HR: 1·08; 95% CI: 0·95-1·22). The data were prone to confounding, selection bias and reporting bias. Certainty of the evidence was very low. CONCLUSION Sex-mismatched RBC transfusions were associated with an increased risk of death in this pooled analysis. However, the certainty of the evidence was very low from observational studies. The need to match donor and recipient sex for transfusions requires further investigation because of the potential widespread impact.
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Affiliation(s)
- Michelle P Zeller
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.,Canadian Blood Services, Medical Office, Hamilton, ON, Canada.,Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Bram Rochwerg
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Erin Jamula
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Na Li
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Christopher Hillis
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.,Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Jason P Acker
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.,Centre for Innovation, Canadian Blood Services, Edmonton, AB, Canada
| | - Ryan J R Runciman
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Shannon J Lane
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Naveen Ahmed
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada
| | - Donald M Arnold
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.,Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nancy M Heddle
- McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.,Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada
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D'Alessandro A. From omics technologies to personalized transfusion medicine. Expert Rev Proteomics 2019; 16:215-225. [PMID: 30654673 DOI: 10.1080/14789450.2019.1571917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/08/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Blood transfusion is the single most frequent in-hospital medical procedure, a life-saving intervention for millions of recipients worldwide every year. Storage in the blood bank is an enabling strategy for this critical procedure, as it logistically solves the issue of making ~110 million units available for transfusion every year. Unfortunately, storage in the blood bank promotes a series of biochemical and morphological changes to the red blood cell that compromise the integrity and functionality of the erythrocyte in vitro and in animal models, and could negatively impact transfusion outcomes in the recipient. Areas covered: While commenting on the clinical relevance of the storage lesion is beyond the scope of this manuscript, here we will review recent advancements in our understanding of the storage lesion as gleaned through omics technologies. We will focus on how the omics-scale appreciation of the biological variability at the donor and recipient level is impacting our understanding of red blood cell storage biology. Expert commentary: Omics technologies are paving the way for personalized transfusion medicine, a discipline that promises to revolutionize a critical field in medical practice. The era of recipient-tailored additives, processing, and storage strategies may not be too far distant in the future.
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Affiliation(s)
- Angelo D'Alessandro
- a Department of Biochemistry and Molecular Genetics , University of Colorado Denver - Anschutz Medical Campus , Aurora , CO , USA
- b Department of Medicine - Division of Hematology , University of Colorado Denver - Anschutz Medical Campus , Aurora , CO , USA
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Ikebe E, Matsuoka S, Tanaka A, Yonemura Y, Fujii Y, Ohsaka A, Okazaki H, Kitazawa J, Ohtani S, Nakayama T, Momose SY, Miwa I, Taira R, Toyota K, Kino S, Kato H, Hamaguchi I. Reduction in adverse transfusion reactions with increased use of washed platelet concentrates in Japan-A retrospective multicenter study. Transfus Apher Sci 2019; 58:162-168. [PMID: 30670326 DOI: 10.1016/j.transci.2018.12.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/27/2018] [Accepted: 12/31/2018] [Indexed: 12/28/2022]
Abstract
Plasma removal by washing platelet concentrates (PCs) is effective in preventing adverse reactions to PC transfusions. The Japanese Red Cross Society (JRCS) started releasing washed PCs (WPCs) as a commercially approved blood product in September 2016. This retrospective multicenter study investigated the change in the number of transfused WPCs and the impact on the incidence of adverse reactions to PCs before and after the release. The numbers and types of transfused PCs and the adverse reactions to the PCs for a year before the start of the WPC release and for a year after the release were reported by 27 medical institutes in Japan. Transfusion information for approximately 8% of the amount of PCs supplied in Japan was analyzed during the study period. After the start of WPC release by the JRCS, the number of transfused WPCs doubled. The rate of adverse reactions to PCs decreased significantly (p = 0.0223), from 4.30% before the release to 4.05% after the release. The rates of adverse reactions to unwashed and WPCs were 4.13% and 0.84%, respectively. Allergic adverse reactions were significantly decreased after the release (3.60% before versus 3.37% after). No severe allergic reactions to WPCs were reported. The release of WPCs by the JRCS significantly reduced transfusion-related adverse reactions to PCs in Japan.
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Affiliation(s)
- Emi Ikebe
- Department of Safety Research on Blood and Biological Products, National Institute of Infectious Diseases, Tokyo, Japan
| | - Sahoko Matsuoka
- Department of Safety Research on Blood and Biological Products, National Institute of Infectious Diseases, Tokyo, Japan
| | - Asashi Tanaka
- Department of Blood Transfusion, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Yuji Yonemura
- Department of Transfusion Medicine and Cell Therapy, Kumamoto University Hospital, Kumamoto, Japan
| | - Yasuhiko Fujii
- Department of Transfusion Medicine, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Akimichi Ohsaka
- Department of Transfusion Medicine and Stem Cell Regulation, Juntendo University School of Medicine, Tokyo, Japan
| | - Hitoshi Okazaki
- Department of Transfusion Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Junichi Kitazawa
- Department of Transfusion Medicine and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan; Division of Clinical Laboratory, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Shinichi Ohtani
- Department of Transfusion Medicine and Cell Transplantation, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takayuki Nakayama
- Department of Transfusion Medicine, Aichi Medical University, Aichi, Japan
| | - Shun-Ya Momose
- Japanese Red Cross Kinki Block Blood Center, Osaka, Japan
| | - Izumi Miwa
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Rikizo Taira
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Kuro Toyota
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Shuichi Kino
- Japanese Red Cross Hokkaido Block Blood Center, Sapporo, Japan
| | - Hidefumi Kato
- Department of Transfusion Medicine, Aichi Medical University, Aichi, Japan
| | - Isao Hamaguchi
- Department of Safety Research on Blood and Biological Products, National Institute of Infectious Diseases, Tokyo, Japan.
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Kipkeu BJ, Almizraq R, Branch DR, Acker JP, Holovati JL. Red cell supernatant effects on endothelial cell function and innate immune activation is influenced by donor age and sex. ACTA ACUST UNITED AC 2018. [DOI: 10.1111/voxs.12472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Betty J. Kipkeu
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton AB Canada
| | - Ruqayyah Almizraq
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton AB Canada
| | - Donald R. Branch
- Centre for Innovation; Canadian Blood Services; Toronto ON Canada
- Department of Medicine; University of Toronto; Toronto ON Canada
| | - Jason P. Acker
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton AB Canada
- Centre for Innovation; Canadian Blood Services; Edmonton AB Canada
| | - Jelena L. Holovati
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton AB Canada
- Centre for Innovation; Canadian Blood Services; Edmonton AB Canada
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Heddle NM, Cook RJ, Liu Y, Zeller M, Barty R, Acker JP, Eikelboom J, Arnold DM. The association between blood donor sex and age and transfusion recipient mortality: an exploratory analysis. Transfusion 2018; 59:482-491. [DOI: 10.1111/trf.15011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/09/2018] [Accepted: 09/23/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Nancy M. Heddle
- McMaster Centre for Transfusion ResearchMcMaster University Hamilton Ontario Canada
- Department of Medicine, Faculty of Health SciencesMcMaster University Hamilton Ontario Canada
| | - Richard J. Cook
- McMaster Centre for Transfusion ResearchMcMaster University Hamilton Ontario Canada
- Department of Statistics and Actuarial ScienceUniversity of Waterloo Waterloo Ontario Canada
| | - Yang Liu
- McMaster Centre for Transfusion ResearchMcMaster University Hamilton Ontario Canada
| | - Michelle Zeller
- McMaster Centre for Transfusion ResearchMcMaster University Hamilton Ontario Canada
- Department of Medicine, Faculty of Health SciencesMcMaster University Hamilton Ontario Canada
- Medical OfficeCanadian Blood Services Hamilton Ontario Canada
| | - Rebecca Barty
- McMaster Centre for Transfusion ResearchMcMaster University Hamilton Ontario Canada
| | - Jason P. Acker
- Centre for InnovationCanadian Blood Services Edmonton Alberta Canada
- Department of Laboratory Medicine and PathologyUniversity of Alberta Edmonton Alberta Canada
| | - John Eikelboom
- Department of Medicine, Faculty of Health SciencesMcMaster University Hamilton Ontario Canada
| | - Donald M. Arnold
- McMaster Centre for Transfusion ResearchMcMaster University Hamilton Ontario Canada
- Department of Medicine, Faculty of Health SciencesMcMaster University Hamilton Ontario Canada
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Van Laecke S, Malfait T, Schepers E, Van Biesen W. Cardiovascular disease after transplantation: an emerging role of the immune system. Transpl Int 2018; 31:689-699. [PMID: 29611220 DOI: 10.1111/tri.13160] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/12/2018] [Accepted: 03/22/2018] [Indexed: 02/06/2023]
Abstract
Cardiovascular disease (CVD) after transplantation remains a major concern. Little is known about what drives the increased cardiovascular risk in transplant recipients apart from traditional risk factors. The immune system is involved in the pathogenesis of hypertension, atherosclerosis, and coronary artery disease in the general population. Recently, inhibition of interleukin 1 - β by canakinumab versus placebo decreased the incidence of cardiovascular events. Emerging evidence points to a role of adaptive cellular immunity in the development of CVD. Especially, expansion of pro-inflammatory and antiapoptotic cytotoxic CD4+ CD28null T cells is closely associated with incident CVD in various study populations including transplant recipients. The association of cytomegalovirus exposure with increased cardiovascular mortality might be explained by its capacity to upregulate these cytotoxic cells. Also, humoral immunity seems to be relevant for cardiovascular outcome in transplant recipients. Panel-reactive antibodies at baseline and donor-specific antibodies are independently associated with poor cardiovascular outcome after kidney transplantation. Cardiovascular effects of immunosuppressive drugs and statins do not only imply indirect positive or negative effects on traditional cardiovascular risk factors but also intrinsic immunological effects. How immunosuppressive drugs modify atherosclerosis largely remains elusive.
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Affiliation(s)
| | - Thomas Malfait
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Eva Schepers
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Wim Van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
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Juffermans NP. Outcome of red blood cell transfusion: ladies first, but perhaps not in donation. J Thorac Dis 2018; 10:641-643. [PMID: 29608183 DOI: 10.21037/jtd.2018.01.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nicole P Juffermans
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, Amsterdam, the Netherlands
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Affiliation(s)
- Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andrés Conthe
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Incorrect Data in Tables. JAMA 2018; 319:724. [PMID: 29466568 PMCID: PMC8177161 DOI: 10.1001/jama.2018.0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kuldanek S, Silliman CC. Mortality after red blood cell transfusions from previously pregnant donors: complexities in the interpretation of large data. J Thorac Dis 2018; 10:648-652. [PMID: 29608196 PMCID: PMC5864649 DOI: 10.21037/jtd.2018.01.77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/09/2018] [Indexed: 01/28/2023]
Affiliation(s)
- Susan Kuldanek
- School of Medicine, University of Colorado Denver, Aurora, CO, USA
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Increased Mortality in Male Recipients of Red Cells from ever Pregnant Female Donors: mHAGs on Red Cells to Blame? Mediterr J Hematol Infect Dis 2018; 10:e2018009. [PMID: 29327738 PMCID: PMC5760068 DOI: 10.4084/mjhid.2018.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/11/2017] [Indexed: 11/29/2022] Open
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[Not Available]. MMW Fortschr Med 2017; 159:3. [PMID: 29071648 DOI: 10.1007/s15006-017-0142-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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