Background/Case Studies: Recent studies have concentrated on donor characteristics to develop personalized transfusion strategies that minimize adverse events in critically ill patients. This research aimed to investigate the impact of sex-matched and sex-mismatched donor-recipient pairs on red blood cell (RBC) transfusion efficacy by exploring hemoglobin level increases (i.e., increments) in recipients.
Study
Design/Methods: A data-linked strategy analysis was performed using data from the blood supplier donor database and patients from a large clinical database in an academic hospital. Adult patients who received their first single allogeneic RBC transfusion in the hospital’s intensive care unit between 2010 and 2020 were identified. Hemoglobin increments were determined by comparing the last hemoglobin result in the 24-hour period pre-RBC unit issue and the first hemoglobin result within 4-24 hours after the RBC unit issued for transfusion. Univariate and multivariate linear regression models were conducted for post-transfusion hemoglobin increment with a four-level exposure variable (female to female, male to male, male to female, and female to male) and adjusting for additional covariates, including recipient demographics (age, most responsible diagnosis, ABO group, pre-transfusion hemoglobin), the time interval between post-transfusion hemoglobin and transfusion, and donor characteristics (donor age, pre-donation hemoglobin).
Results/Findings: Female recipients exhibited lower hemoglobin increments from female donors (9.0 g / L ± 10.2 g / L, n = 654) than from male donors (10.9 g / L ± 10.3 g / L, n = 849; mean difference -1.9 g / L with p < 0.01). In contrast, male recipients showed no significant difference in hemoglobin increments when receiving blood from female (6.2 g / L ± 9.7 g / L, n = 852) or male donors (6.8 g / L ± 10.0 g / L, n = 1132; mean difference -0.6 g / L with p = 0.17). Donor pre-donation hemoglobin, recipient age, most responsible diagnosis, and pre-transfusion hemoglobin were significant predictors of hemoglobin increments (p < 0.05). Conclusions: Male blood boosted hemoglobin significantly higher than female blood in female recipients but not in males. Donor pre-donation hemoglobin, recipient sex, age, most responsible diagnosis, and pre-transfusion hemoglobin were associated with hemoglobin increments in critically ill patients. These findings provide insight into the development of a more personalized blood product selection strategy for critically ill patients.
Importance of research: The examination of hemoglobin increments in critically ill patients reinforced the impact of both donor and recipient factors on hemoglobin improvement. Notably, the hemoglobin increase was significantly affected by pre-donation hemoglobin rather than donor sex. These insights could potentially direct the choice of blood products for transfusion in intensive care unit patients, taking into account the unique features of both donors and recipients to improve patient outcomes.
