Blood donor characteristics linked to outcomes of very low-birth-weight infants
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Very low-birth-weight infants who received blood transfusions from female donors had a lower risk for mortality and/or serious morbidity than those who received transfusions from male donors, study results showed.
The protective benefit appeared to increase with donor age — with blood from older, female donors linked to the lowest risk for adverse outcomes — but declined with increasing number of transfusions, according to the results, published in JAMA Network Open.
“There has been a substantial focus in the neonatal field on when to transfuse preterm infants, such as the use of a particular hemoglobin threshold, but relatively little focus on what is being transfused into preterm infants,” Ravi M. Patel, MD, MSc, associate professor of pediatrics and director of clinical research in the division of neonatology at Emory University School of Medicine and Children’s Healthcare of Atlanta, told Healio. “We wanted to examine factors that could influence the characteristics of red blood cells used for blood transfusion — specifically the sex and age of blood donors — based on prior studies in adults suggesting these factors could impact outcomes.”
Patel and colleagues assessed the association of blood donor sex and age with mortality or serious morbidity among 181 very low-birth-weight infants (mean gestational age, 27 weeks; mean birth weight, 919 g) who received blood transfusions across three hospitals in Atlanta between January 2010 and February 2014. Mean donor age was 46.6 years.
Follow-up occurred until 90 days, hospital discharge, transfer to a nonstudy-affiliated hospital or death.
A composite outcome of death, necrotizing enterocolitis, retinopathy of prematurity or moderate-to-severe bronchopulmonary dysplasia served as the primary outcome.
Overall, 31% of infants received red blood cell transfusion exclusively from female donors.
Results showed incidence of the primary outcome was 21% among infants who received transfusions exclusively from female donors vs. 45% among infants who received transfusions exclusively from male donors.
Researchers also observed significant associations between female donor and donor age (P for interaction = .005) as well as female donor and number of transfusions (P for interaction < .001). Transfusions exclusively from female donors were associated with a lower risk for the primary outcome among infants who received a median of two transfusions (RR = 0.29; 95% CI, 0.16-0.54).
The protective effect of transfusions exclusively from female donors on the primary outcome increased as donor age increased, but attenuated as the number of transfusions increased, according to the researchers.
Limitations of the study included the fact that investigators could not assess additional donor characteristics, such as smoking, pregnancy or medication use, and use of the composite outcome may have been limited by divergent associations within individual components of the primary composite outcome.
“Our findings highlight the importance of not only considering when blood transfusions are administered, but understanding how the characteristics of the blood being transfused might influence outcomes. Blood donor factors, such as sex and age, are two of many factors that might be important to consider,” Patel said. “However, our findings need additional study, including confirmation in other studies, before any changes in practice are warranted. We are now interested in examining what potential mechanisms could explain our findings by studying in more detail how blood characteristics differ by sex. We are also interested in studying how physiologic responses to blood transfusion in very preterm infants could differ based on the sex of a blood donor.”
For more information:
Ravi M. Patel, MD, MSc, can be reached at Emory University School of Medicine and Children’s Healthcare of Atlanta, 2015 Uppergate Drive NE, Room 312, Atlanta, GA 30322; email: rmpatel@emory.edu.
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