Sex of red blood cell donor has no significant impact on transfusion recipient mortality
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Key takeaways:
- Laboratory evidence and observational studies had suggested a benefit of a male donor strategy.
- Additional trials are needed to investigate other potential donor characteristics.
The sex of red blood cell donors did not have a significant impact on survival outcomes of transfusion recipients, according to study results published in The New England Journal of Medicine.
Results of prior observational studies suggested recipients of red cells from female donors may have poorer survival outcomes compared with those who received red cells from male donors, but evidence to guide transfusion strategies had been limited.
“I was surprised that we found no benefit of a male donor strategy compared [with] a female donor strategy, as laboratory evidence and our observational studies and those of others pointed toward a significant benefit,” Dean A. Fergusson, MHA, PhD, FCAHS, senior scientist and director of the clinical epidemiology program at Ottawa Hospital Research Institute, told Healio. “It demonstrates the power and need of randomized controlled trials to answer important questions.”
Methodology and results
Fergusson and colleagues conducted the double-blind, multicenter Trial Assessing Donor Sex on Recipient Mortality among 8,719 hospital patients (median age, 69 years; interquartile range, 58-78) randomly assigned to receive red blood cell units from male (n = 5,190) or female (n = 3,529) donors. The 60:40 ratio matched the blood supplier’s historical allocation of red blood cell units.
Most patients (79.9%) received their first transfusion in the impatient setting, and among them, 2,942 (42.2%) had previously been admitted under a surgical service.
Patients had a baseline hemoglobin level prior to first transfusion of 79.5 ± 19.7 g/L. Those in the female donor group received a mean of 5.4 ± 10.5 units of red blood cells, whereas those in the male donor group received a mean 5.1 ± 8.9 units (difference = 0.3 units; 95% CI, 0.1 to 0.7).
Survival served as the primary outcome, with the male donor group as the reference group.
During the trial, 1,712 patients in the male donor group and 1,141 patients in the female donor group died (adjusted HR for death = 0.98; 95% CI, 0.91-1.06). Researchers observed no differences between the groups in secondary outcomes, although they noted a higher incidence of MRSA infection among the female donor group (HR = 2; 95% CI, 1.15-3.46).
Study limitations included a potential lack of generalizability of the findings to other jurisdictions that have substantially different blood bank practices or red cell products.
Next steps
Additional trials can work to identify donor characteristics other than sex that may have a significant impact on recipient survival, Fergusson said.
“Our data confirm that current blood collection, blood bank and clinical practices do not need to be changed, as male donors do not confer a clinical benefit,” he told Healio. “Next steps would be to evaluate other donor characteristics such as donor age and their effect on recipient outcomes.”
For more information:
Dean A. Fergusson, MHA, PhD, FCAHS, can be reached at Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON K1H 8L6; email: dafergusson@ohri.ca.
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