Mortality after transfusions, relation to donor sex.

Middelburg RA, Briet E, van der Bom JG

Vox Sang 2011;101:221-229.

NATA Rating :
Review by : R. Moog
NATA Review

The present study provides a model about mortality after transfusion related to donor gender. During a 5-year period a cohort study of transfusion recipients was performed at a single University Medical Center.

In the past years female donors were identified to cause severe adverse transfusion reactions such as TRALI. Donor leukocyte antibodies transfused to the patient result in increased morbidity and mortality. As a consequence female plasma for transfusion is banned in some countries or a negative leukocyte antibody screen is required before releasing female plasma. Some TRALIs have been reported after RBC transfusion indicating that other factors might cause transfusion reactions in the recipient. In the present study blood transfusion from female donors appeared not to be associated with a higher mortality than from male donors. However, among male patients blood from female donors was associated with a higher mortality, whereas among female recipients blood from male donors showed a weaker increase in mortality.

The cohort study has several limitations:
1) The study population consisted of patients having received only a single transfusion or multiple transfusions. Patients with more than one transfusion usually show higher mortality which may be a bias.
2) No information about deferral of female donors with pregnancies is given. This might have been introduced in The Netherlands during the study period and should have resulted in less TRALIs when plasma was transfused.
3) The study lacks statistical power as it is only a single center study resulting in 900 deaths. The observed increase in mortality for female recipients of blood products from male donors might be attributed to chance.
4) No data about the causes of death were provided. This limitation was also due to a lack of power, preventing analyses in many cause-of-death-specific subgroups.

– Rainer Moog