Abstract
There are conflicting data on the association between blood donor characteristics and outcomes among patients receiving transfusions. To evaluate the association of blood donor sex and age with mortality or serious morbidity in very low-birth-weight (VLBW) infants receiving blood transfusions. This is a cohort study using data collected from 3 hospitals in Atlanta, Georgia. VLBW infants (≤1500 g) who received red blood cell (RBC) transfusion from exclusively male or female donors were enrolled from January 2010 to February 2014. Infants received follow-up until 90 days, hospital discharge, transfer to a non-study-affiliated hospital, or death. Data analysis was performed from July 2019 to December 2020. Donor sex and mean donor age. The primary outcome was a composite outcome of death, necrotizing enterocolitis (Bell stage II or higher), retinopathy of prematurity (stage III or higher), or moderate-to-severe bronchopulmonary dysplasia. Modified Poisson regression, with consideration of covariate interactions, was used to estimate the association between donor sex and age with the primary outcome, with adjustment for the total number of transfusions and birth weight. In total, 181 infants were evaluated, with a mean (SD) birth weight of 919 (253) g and mean (SD) gestational age of 27.0 (2.2) weeks; 56 infants (31%) received RBC transfusion from exclusively female donors. The mean (SD) donor age was 46.6 (13.7) years. The primary outcome incidence was 21% (12 of 56 infants) among infants receiving RBCs from exclusively female donors, compared with 45% (56 of 125 infants) among those receiving RBCs from exclusively male donors. Significant interactions were detected between female donor and donor age (P for interaction = .005) and between female donor and number of transfusions (P for interaction < .001). For the typical infant, who received a median (interquartile range) of 2 (1-3) transfusions, RBC transfusion from exclusively female donors, compared with male donors, was associated with a lower risk of the primary outcome (relative risk, 0.29; 95% CI, 0.16-0.54). The protective association between RBC transfusions from female donors, compared with male donors, and the primary outcome increased as the donor age increased, but decreased as the number of transfusions increased. These findings suggest that RBC transfusion from female donors, particularly older female donors, is associated with a lower risk of death or serious morbidity in VLBW infants receiving transfusion. Larger studies confirming these findings and examining potential mechanisms are warranted.
Highlights
Very low-birth-weight (VLBW) infants commonly receive red blood cell (RBC) transfusions.[1]
For the typical infant, who received a median of 2 (1-3) transfusions, RBC transfusion from exclusively female donors, compared with male donors, was associated with a lower risk of the primary outcome
The protective association between RBC transfusions from female donors, compared with male donors, and the primary outcome increased as the donor age increased, but decreased as the number of transfusions increased
Summary
Very low-birth-weight (VLBW) infants commonly receive red blood cell (RBC) transfusions.[1] Recent randomized clinical trials[2,3] comparing higher vs lower hemoglobin transfusion thresholds have not reported harm with the use of more liberal hemoglobin transfusion thresholds These trials indicate that more liberal approaches to RBC transfusion are not harmful in preterm infants, they lacked measurement and evaluation of blood donor characteristics. Only 1 prior study[9] evaluating donor sex has been conducted of VLBW infants and reported that transfusion of RBCs from female donors, compared with male donors, was associated with a higher risk of morbidity and mortality in preterm infants, but this association was no longer significant after accounting for the number of transfusions. No prior studies have evaluated the effect of donor age on recipient outcomes in preterm infants receiving RBC transfusions
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