Transfusion from male-only vs female donors in critically ill recipients of high plasma volume components

Objective

To reduce the incidence of transfusion-related acute lung injury (ALI), the American Association of Blood Banks (AABB) has recently recommended rapid implementation of strategies to minimize transfusion of high plasma volume components, fresh frozen plasma and apheresis platelets, from potentially alloimunized donors, especially females. The objective of this study was to evaluate the effect of transfusing components from male-only vs female donors on development of ALI, gas exchange, and outcome in critically ill patients.

Methods

In this retrospective case–control study we identified patients who received more than two units of high plasma volume components from male-only donors and compared them with patients matched by severity of illness, postoperative state and number of transfusions but who received high plasma volume components from female donors.

Results

From a database of 3,567 patients who received a total of 46,101 units fresh frozen plasma and 6,251 units apheresis platelets, we identified 112 patients who received three or more male-only donor components and 112 matched controls. Baseline characteristics, ALI risk factors and development of ALI were similar between the two groups. Arterial oxygenation (PaO₂/FiO₂) worsened after the female donor components (mean difference -52, 95% CI -14 to -91, P = 0.008) but not after male-only donor product transfusion (mean difference +22, 95% CI -23 to + 67, P = 0.325). Male-only component recipients had more ventilator-free days (median 28 vs 27, P = 0.006) and a trend towards lower hospital mortality (14% vs 24%, P = 0.054).

Conclusion

In critically ill recipients of high plasma volume components, gas exchange worsened significantly after transfusion of female but not male donor components. Prospective studies are needed to evaluate the effect of AABB recommendations on outcome of transfused critically ill patients.