24 June 2022

Red blood cell transfusions from female donors are as safe as those from male donors, new research has found – although haemoglobin levels are often lower.

Previous research has suggested that plasma and platelet transfusions from female donors and women who have had children may be linked to adverse outcomes. This has led to the preferential use of plasma products from male donors. However, whether the sex or pregnancy history of red blood cell donors affect recipient survival is still not clear, and studies have shown conflicting results.

So Dr Jingcheng Zhao of the Karolinska Institutet, Sweden, and his team carried out a study to examine data from nationwide blood bank and health registers in Sweden. Survival outcomes from 368,778 male and female patients were analysed.

Two-year survival after red blood cell transfusion was similar, regardless of the sex of the donor, whether a female donor had ever had a baby, or the age of the donor.

Transfusion recipients were about 12% more likely to need an additional red blood cell transfusion within 24 hours after a transfusion from a female donor. However, this difference was entirely explained by the lower donor haemoglobin counts; median haemoglobin counts were 135g/l for female blood donors and 149 g/l for male donors.  

“In this nationwide cohort study involving a natural experiment, after accounting for the lower haemoglobin values in blood from female donors, patients undergoing transfusion with blood from female or parous donors did not have higher two-year mortality compared with recipients of blood from male donors,” the researchers write in JAMA Internal Medicine.

Dr Zhao said: “Differences in haemoglobin levels are a source of error that previous studies have not taken into consideration and that might explain the conflicting results that has been seen previously.”

Source: Zhao J, Sjölander A, Edgren G. (2022) “Mortality Among Patients Undergoing Blood Transfusion in Relation to Donor Sex and Parity: A Nationwide Natural Experiment.” JAMA Internal Medicine, doi: 10.1001/jamainternmed.2022.2115

Link: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2793235

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