Association of Blood Donor Age and Sex With Recipient Survival After Red Blood Cell Transfusion

Abstract

ed blood cell (RBC) transfusion is the most common medical procedure in contemporary medicine. 1 In the United States, 7.6% of all hospitalized patients will receive at least 1 blood transfusion during their hospitalization, and its use has increased between 1997 and 2011 by 134%. 1 With the main objective to improve oxygen delivery to tissues, 2 RBC transfusion is used in a variety of medical situations, ranging from correction of chronic low-grade anemia to resuscitation of the massively bleeding patient. 2-5 When a decision to transfuse has been made, usual practice is to order 1 or more compatible RBC units from the blood bank. Limited characteristics of the RBC unit can be requested, such as cytomegalovirus (CMV) status, leukoreduction, or irradiation; however, evidence of clinical benefit with these specific characteristics is limited. 6 There is growing preclinical and clinical evidence that blood donor characteristics may affect recipient outcomes. Erythropoiesis is altered by aging, 7 as are other characteristics related to blood, including immune tolerance, inflammation, oncogenicity, and premature cellular turnover. 8,9 Humans who live longer may also have different genetic factors affecting RBC characteristics. 10 Immunological phenomena related to donors, such as the antileukocyte antibodies (anti-HLA or antineutrophil antibodies) that occur after pregnancies (eg, sex effect on transfusion-related acute lung injury [TRALI]), have been shown to affect clinical outcomes. 11,12 Transfusion of a blood component is analogous to solid organ transplantation because it involves the retrieval of an organ (blood) from a donor, postdonation processing and IMPORTANCE While red blood cells (RBCs) are administered to improve oxygen delivery and patient outcomes, they also have been associated with potential harm. Unlike solid organ transplantation, the clinical consequences of donor characteristics on recipients have not been evaluated in transfusion medicine. OBJECTIVE To analyze the association of RBC donor age and sex with the survival of transfusion recipients. DESIGN, SETTING, AND PARTICIPANTS We established a longitudinal cohort by linking data from a blood collection agency with clinical and administrative data at 4 academic hospitals. MAIN OUTCOMES AND MEASURES Cox proportional hazards regression models were fitted to evaluate the risk of donor age and sex on transfusion recipient survival.

Mortality after red blood cell transfusions from previously pregnant donors: complexities in the interpretation of large data

“…Furthermore, the authors speculate that residual confounding, likely patient underlying disease severity, due to imperfect measurement of the confounding variable leading to its incomplete removal, may account for the positive results observed in other studies. These results were contrary to those observed by Chassé et al (4). As per eTable 10, the deleterious effects of EPF RBCs remained, again in the younger males, after controlling for the cumulative number of plasma and platelet units received.…”

“…Other policies and advances in cell preservation technology such as ABO and Rh matching, leukoreduction and limitations in the age of storage (to the age of RBC viability) of blood products have decreased recipient morbidity and mortality (1)(2)(3). However, the concept that RBC donor female gender and parity may influence recipient mortality has been a subject of much debate in the blood banking community and differing conclusions are reported in several large retrospective studies (4,5). Here we comment on the recent article by Caram-Deelder et al (6) published in JAMA reporting increased mortality in male recipients of RBC units from female donors who had ever been pregnant compared with male recipients of RBC units from male donors.…”

Association of Donor Age and Sex With Survival of Patients Receiving Transfusions

“…22 The second study, based on Canadian data, used a more complex, time-dependent survival model and conversely reported increased risks of death among recipients of blood from young and female donors. 21 The difference between the findings of these 2 studies is striking. If the Canadian findings are true, they would have immediate implications for transfusion medicine practice.…”

“…Most recently, following reports from animal model studies suggesting that transfusions from young donors may have rejuvenating effects in older recipients, [15][16][17][18][19][20] there have been at least 2 observational studies investigating whether donor age influences the survival of patients receiving transfusions. 21,22 The studies used dissimilar statistical methods and reported conflicting results. In the first study, which was based on the Scandinavian Donations and Transfusions (SCANDAT2) database, 23 a matched cohort design was used, and no associations were found between donor age and mortality of patients who received transfusions.…”

“…If the Canadian findings are true, they would have immediate implications for transfusion medicine practice. To understand and explain these differences and ultimately reconcile the contradictory results, we conducted a new retrospective cohort study based on the SCANDAT2 database in which we used methods similar to those used in the Canadian study by Chassé et al 21 …”