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Female-to-Male RBC Transfusions Linked to ICU Mortality

May 31, 2022

June 2022

Linda Kossoff

Linda Kossoff is a medical writer based in Los Angeles.

There are significant associations between male patients who received a transfusion of red blood cells (RBCs) from female donors and intensive care unit (ICU) mortality, according to study findings published in Blood Advances.

A growing body of evidence suggests that RBC transfusion might be associated with increased mortality risk, although the mechanisms underlying this association are unknown. This multicenter study aimed to investigate associations between donor sex and post-transfusion mortality and ICU-acquired complications in critically ill patients who received unisex transfusions only. Hypothesizing that transfusing female blood to men is associated with worse outcomes, researchers applied survival analysis and multivariate logistic analysis to investigate the association between donor sex and ICU mortality. The primary outcome was a 30-day ICU mortality measured from the ICU admission date.

A total of 403 patients were divided into four groups: women who received transfusions from female donors (n=77), men who received transfusions from female donors (n=106), women who received transfusions from male donors (n=90), and men who received transfusions from male donors (n=130). Groups did not differ in baseline characteristics or transfusion-related parameters.

The female-to-female group showed the best survival, while the female-to-male group had the highest mortality compared to the reference group (p<0.05). The multivariate logistic analysis showed that donor-recipient sex mismatch independently contributed to mortality (odds ratio [OR] = 2.43, 95% CI 1.02-5.77; p<0.05) compared to the sex-matched transfused group. Patient age, sepsis, and length of ICU stay contributed significantly to the ICU mortality (OR=1.87, 95% CI 1.34-2.63; OR=2.25, 95% CI 1.32-3.83; OR=0.94, 95% CI 0.89-0.99, respectively; p<0.05). The number of RBC units transfused marginally contributed to the prediction of mortality (OR=1.19, 95% CI 0.98-1.43; p=0.08).

There were no statistically significant differences between the four groups of unisex transfusions and ICU-acquired complications. Acute kidney injury incidence was higher in donor-recipient sex-matched groups (female-to-female and male-to-male) when compared to the sex-​mismatched groups (p=0.05). The receipt of female blood was associated with a trend toward increased risk of developing acute respiratory distress syndrome (ARDS) compared to the receipt of male blood, although the correlation was not statistically significant (p=0.06).

“Although our results are observational and need confirmation in controlled trials, results are hypothesis generating,” according to the researchers. “If indeed donor sex is a relevant factor, this should be included during the cross-matching procedure.”

Researchers further stated that these results may inform studies investigating whether matching donor and recipient sex improves outcomes among critically ill patients in need of a transfusion, and male recipients in particular.

Study limitations included its exploratory nature, which allowed for potential uncontrolled confounders that limit broad generalization of the findings. Also, donor sex of non-RBC product transfusions, such as plasma and platelets, was not considered.

Any conflicts of interest declared by the authors can be found in the original article.

Reference

Alshalani A, Uhel F, Cremer O, et al. Donor-recipient sex is associated with transfusion-related outcomes in critically ill patients [published online ahead of print, 2022 Mar 14].Blood Adv. doi: 10.1182/bloodadvances.2021006402.

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