Female donors and transfusion-related acute lung injury: A case-referent study from the International TRALI Unisex Research Group

BACKGROUND

Although quantitative evidence is lacking, it is generally believed that the majority of cases of transfusion-related acute lung injury (TRALI) are caused by female blood donors. We aimed to examine the relation between female donors and the occurrence of TRALI.

STUDY DESIGN AND METHODS

We performed an international, multicenter case-referent study. TRALI patients who were diagnosed clinically, independent of serology or donor sex, and had received transfusions either only from male donors or only from female donors (unisex cases) were selected. The observed sex distribution among the donors of these TRALI patients was compared to the expected sex distribution, based on the relevant donor populations.

RESULTS

Eighty-three clinical TRALI cases were included; 67 cases received only red blood cells (RBCs), 13 only plasma-rich products, and three both. Among RBC recipients the relative risk (RR) of TRALI after a transfusion from a female donor was 1.2 (95% confidence interval [CI], 0.69-2.1) and among plasma-rich product recipients the RR was 19 (95% CI, 1.9-191). The p value for the difference between RBCs and plasma was 0.023.

CONCLUSION

Our data support the notion that plasma from female donors is associated with an increased risk of TRALI, while RBCs from female donors are not.

No protective effect of breastfeeding on inhibitor formation in severe hemophilia

It has been suggested that breastfeeding may prevent inhibitor formation in patients with hemophilia. In a single-center retrospective cohort study, the authors studied the association between breastfeeding and inhibitor development in 90 severe hemophilia A patients born 1975-2003. Mean follow-up was 13.2 years (standard deviation 8.7). A total of 62% of patients received breastfeeding and 20% developed inhibitors. The inhibitor rate according to breastfeeding was similar: 21% in patients who were breastfed and 18% in others. Patients who were breastfed received their first treatment 0.3 years earlier. After adjustment for age at first treatment, we found no protective effect of breastfeeding on inhibitor formation.

Use of implantable venous access devices in children with severe hemophilia: benefits and burden

BACKGROUND AND OBJECTIVES

Since venous access in small children can be difficult to obtain, implantable venous access devices (IVAD) are used to administer clotting factor in such patients with severe hemophilia. The aim of our study was to evaluate how many children in our center needed an IVAD in order to be able to start early prophylaxis, what the differences were between children who needed an IVAD and those who did not and what the complications of the IVAD were.

DESIGN AND METHODS

All 70 patients with severe hemophilia born between January 1987 and October 2000 treated at our center before they were 6 years old were studied.

RESULTS

An IVAD was placed in 23 children (33%). Children with an IVAD started prophylactic treatment at a mean age of 2 years (SD 1.3), those without at a mean age of 3.6 years (SD 1.6) (p< 0.001). Home treatment was feasible at a mean age of 2.8 years (SD 1.3) in children with an IVAD and at 4.5 years in those without an IVAD (SD 1.8) (p = 0.001). Infection was the most frequent complication; the mean number of infections per IVAD was 0.61. Thrombosis was more common than initially thought (15%). The infection rate in children with inhibitory antibodies was 3.1 per 1000 patient-days; in children without an inhibitor it was 0.72 per 1000 patient-days.

INTERPRETATION AND CONCLUSIONS

In 33% of the children in our cohort an IVAD was needed in order to start early prophylaxis. IVAD are needed more frequently when prophylaxis is started at an early age, but have the advantage that home treatment is feasible earlier. Infection is the most common complication, particularly in children with inhibitors.