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Increased Risk of Mortality with Female to Male Blood Product Transfusions

10 August 2019


Background: Blood product transfusions are one of the most common procedures in the US. These transfusions are considered safe but there is still a risk of complications and mortality. The most common cause of transfusion related mortality being transfusion related acute lung injury (TRALI). TRALI is an acute lung condition that results in dyspnea, cough, and hypoxemia. It is hypothesized that TRALI is an antibody mediated phenomenon that is associated with female donors, as female and multiparous women have more HLA/HNA antibodies in their blood. This review is to investigate if there is increased mortality with the use of female blood products in male recipients.

Methods: An exhaustive literature search using MEDLINE, Web of Science, and CINAHL via EBSCO-host was conducted. The following search terms were used: female, male, transfusion, mortality, donor, and pregnancy. Relevant articles were assessed for quality using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

Results: The literature search yielded 5 qualifying studies, all were retrospective cohort studies. The studies indicated that the use of female blood products did increase mortality among male recipients. Four of the 5 studies did show an increase in mortality among male recipients of female blood product donation. One study found increased mortality among male recipients specifically receiving multiparous female blood products. Another study reported increased mortality among male recipients receiving more than 2 units of female plasma. One study found no increased risk to male recipients receiving female blood products.

Conclusion: Four of the 5 studies reviewed did show consistent results that men are negatively affected by use of female blood products. One study showed no increased risk. Further research is needed to determine the exact cause of increased male mortality and TRALI pathophysiology. In addition, investigations are needed to determine the best use of female blood products. These studies are just a start in truly understanding how sex mismatched blood transfusions affect patients’ bodies in the short and long term.


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