Blood transfusion from female donors with history of pregnancy linked to increased mortality risk in men

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Male blood transfusion recipient all-cause mortality rate from an ever-pregnant female was 101 per 1000 person years.
Male blood transfusion recipient all-cause mortality rate from an ever-pregnant female was 101 per 1000 person years.

Among patients who receive red blood cell transfusions, receiving a transfusion from an ever-pregnant female donor, compared with a male donor, is associated with increased all-cause mortality among male recipients but not among female recipients, according to a study published in JAMA.

Camila Caram-Deelder, MSc, from the Center for Clinical Transfusion Research in Leiden, the Netherlands, and colleagues conducted a retrospective cohort study of first-ever transfusion recipients from May 30, 2005, to September 1, 2015, in 6 major Dutch hospitals. Primary analyses were performed in a “no-donor-mixture” cohort: patients who received all their red blood cell transfusions exclusively from male donors, all exclusively from female donors without a history of pregnancy (never-pregnant donors), or all exclusively from female donors with a history of pregnancy (ever-pregnant donors).

Information on donor dates of birth, sex, and pregnancy before donation were provided by the national Dutch blood supply, Sanquin, and linked to recipients' data using the product identification codes of transfused red blood cells. Information about donors' pregnancy history was not specifically recorded and was missing for 44% of donations from female donors. The primary outcome was all-cause mortality at any time during follow-up.

The cohort consisted of 31,118 patients (median age, 65; 52% female) who received 59,320 red blood cell transfusions exclusively from 1 of 3 types of donors (88% male; 6% ever-pregnant female; and 6% never-pregnant female). The number of deaths in this cohort was 3,969 (13%). For male recipients of red blood cell transfusions, all-cause mortality rates after a red blood cell transfusion from an ever-pregnant female donor vs male donor were 101 vs 80 deaths per 1000 person-years (hazard ratio [HR] for death, 1.13). For receipt of transfusion from a never-pregnant female donor vs male donor, mortality rates were 78 vs 80 deaths (HR, 0.93). Among female recipients of red blood cell transfusions, mortality rates for an ever-pregnant female donor vs male donor were 74 vs 62 (HR, 0.99); for a never-pregnant female donor vs male donor, mortality rates were 74 vs 62 (HR, 1.01).

“Male recipients who received a transfusion from an ever-pregnant female donor had a statistically significant increase in mortality compared with those who received a transfusion from a male donor or from a female donor without a history of pregnancy,” the authors stated. “There was no significant association between pregnancy status of female donors of red blood cells and mortality among female recipients of red blood cell transfusions.”

Reference

Caram-Deelder C, Kreuger AL, Evers D, et al. Association of blood transfusion from female donors with and without a history of pregnancy with mortality among male and female transfusion recipients. JAMA. 2017 Oct 17;318(15):1471-1478. doi: 10.1001/jama.2017.14825.

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