18 June 2019

The pregnancy history or sex of red blood cell donors does not increase the mortality risk of those who receive the products, a new study revealed last week.

Previous studies have suggested that women who have been pregnant should be excluded from donating blood products such as plasma because it contains antibodies that pregnant women develop when exposed to foetal blood.

However, a new study by the US National Heart, Lung, and Blood Institute (NHLBI) into red blood cell transfusions found no increased risk of death in recipients of red blood cells from once-pregnant women.

It adds to a growing body of evidence regarding blood donor characteristics and how they affect the survival of transfused patients.

Dr Simone Glynn, chief of the Blood Epidemiology and Clinical Therapeutics Branch at NHLBI, said the results, which are published in the Journal of the American Medical Association (JAMA), are “reassuring.”

The study team used three large donor-recipient databases for its analyses: the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III); the Kaiser Permanente Northern California (KPNC) health care system; and the Scandinavian Donations and Transfusions (SCANDAT) database from Sweden and Denmark. Together, the three cohorts had data on more than one million patients who had received red blood cell transfusions from 2003 to 2016.

“The results are reassuring in that the survival of patients who got transfused with red blood cells does not appear to be associated with whether the blood they received was donated by a man, by a woman who had been pregnant - or by one who had not,” said Dr Glynn. “That's important to know.”

In the KPNC cohort, 9% of the transfusions were from previously pregnant female donors, 39% from never-pregnant female donors and 44% from donors of the opposite sex of the recipient.

In the REDS-III cohort, 18% of transfusions were from parous donors, 43% from never-pregnant female donors and 49% from donors of the opposite sex. The SCANDAT cohort involved 25% of transfusions from parous donors, 41% from never-pregnant female donors and 50% from donors of the opposite sex.

The researchers found no significant associations between patient mortality and red blood cell transfusions from either the parous, previously pregnant, and never-pregnant female donors or the donors of the opposite sex.

Dr Nareg Roubinian, senior study author and clinical investigator at the Kaiser Permanente Division of Research, Vitalant Research Institute, and the University of California, San Francisco, said: “We looked at three donor groups, and after careful adjustment for the number of transfusions, we didn't find any evidence of an association.

“Given the different geographic locations and sizes of the cohorts, this finding was very consistent and convincing.”

The researchers say they will go on to investigate whether other blood donor and component factors could pose medical problems in transfused patients, focusing on chronically transfused groups of adults and paediatric patients.

Source: Edgren, G., Murphy, E.L., Brambilla, D.J., Westlake, M., Rostgaard, K., Lee, C., Cable, R.G., Triulzi, D., Bruhn, R., St Lezin, E.M., Erikstrup, C., Ullum, H., Glynn, S.A., Kleinman, S., Hjalgrim, H., Roubinian, N.H., for the NHLBI Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) Group. (2019) “Association of Blood Donor Sex and Prior Pregnancy With Mortality Among Red Blood Cell Transfusion Recipients”, JAMA, available from doi: 10.1001/jama.2019.7084


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