Effect of donor, component, and recipient characteristics on hemoglobin increments following red blood cell transfusion

Abstract

This study furnishes evidence that both confirms and refutes a long-standing maxim that a one-unit transfusion of red blood cells should yield a posttransfusion hemoglobin increment of 1 g/dL.

Restrictive blood transfusion – is less really more?

“…Furthermore, recent evidence suggests that blood donor characteristics (e.g. age, sex), collection and processing methods and recipient characteristics, such as age and body mass index, significantly influence changes in haemoglobin concentrations after transfusion . Further research into these areas may allow for a bespoke approach towards transfusion in the future, but this may also have an impact on blood donation strategies.…”

“…Furthermore, recent evidence suggests that blood donor characteristics (e.g. age, sex), collection and processing methods and recipient characteristics, such as age and body mass index, significantly influence changes in haemoglobin concentrations after transfusion [16].…”

A rose is a rose is a rose, or not

“…In this issue of Blood, Roubinian et al provide important evidence to confirm, and refute, a long-standing maxim in clinical medicine that a 1-unit transfusion of red blood cells (RBCs) should yield a posttransfusion hemoglobin increment of 1 g/dL. 1 Although true, in general, this rule was not always accurate, and deviations could be misleading. They evaluated many single-unit transfusion outcomes in stable adult patients by mining electronic health records (EHRs) and linked blood donor data.…”

Blood donor component‐recipient linkages: is there fire where there is smoke?

“…Additional donor, component, and recipient factors may have influenced the results reported by DeSimone et al First and foremost, they acknowledge that their study is limited in size, and thus findings need to be interpreted cautiously and validated in larger prospective or retrospective cohorts. In the study, all RBC units were gamma irradiated, which is known to increase susceptibility to hemolysis and has recently been shown to negatively impact hemoglobin increments in recipients . It is unclear whether donor smoking accentuated the effect of irradiation on RBC hemolysis or clearance or whether the effect of smoking could be limited to RBC units subjected to this component modification.…”

“…To minimize recipient confounding, the study excluded bleeding indications for transfusion as well as the receipt of multiple RBC units in a 24‐hour period. The investigators also compared the prevalence of donor and recipient sex as well as transfused volumes and storage duration for the two comparator groups—each factor a potential modifier of hemoglobin increments after RBC transfusion . Ideally, all of these donor, component, and recipient factors would be examined in concert with detailed donor smoking data and measured levels of tobacco constituents and degradation products as part of a multivariable model rather than by univariate comparisons, but this approach was not feasible given the sample size.…”