title: Transfusion from male-only versus female donors in critically ill recipients of high plasma volume components.
abstract: OBJECTIVE
  To reduce the incidence of transfusion-related acute lung injury (ALI), the American Association of Blood Banks recently recommended rapid implementation of strategies to minimize transfusion of high plasma volume components, fresh frozen plasma and apheresis platelets, from potentially alloimmunized donors, especially females. The objective of this study was to evaluate the effect of transfusing components from male-only vs. female donors on development of ALI, gas exchange, and outcome in critically ill patients.
  
  
  METHODS
  In this retrospective case-control study, we identified patients who received high plasma volume components from male-only donors and compared them with patients matched by severity of illness, postoperative state, and number of transfusions but who received high plasma volume components from female donors.
  
  
  METHODS
  Four intensive care units at a tertiary medical center.
  
  
  METHODS
  Critically ill patients who received >2 units of fresh frozen plasma or apheresis platelets.
  
  
  METHODS
  None.
  
  
  RESULTS
  From a database of 3,567 patients who received a total of 46,101 units of fresh frozen plasma and 6,251 units of apheresis platelets, we identified 112 patients who received three or more male-only donor components and 112 matched controls. Baseline characteristics, ALI risk factors, and development of ALI were similar between the two groups. Arterial oxygenation (PaO2/FIO2) worsened after the female (mean difference -52, 95% confidence interval -14 to -91, p = .008) but not after male-only donor product transfusion (mean difference 22, 95% confidence interval -23 to 67, p = .325). Male-only component recipients had more ventilator-free days (median 28 vs. 27, p = .006) and a trend toward lower hospital mortality rates (14% vs. 24%, p = .054).
  
  
  CONCLUSIONS
  In critically ill recipients of high plasma volume components, gas exchange worsened significantly after transfusion of female but not male donor components. Prospective studies are needed to evaluate the effect of recommendations by the American Association of Blood Banks on outcome of transfused critically ill patients.
authors.affiliation: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA. gajic.ognjen@mayo.edu
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
authors.forename: Murat
authors.initials: M
authors.lastname: Yilmaz
authors.forename: Remzi
authors.initials: R
authors.lastname: Iscimen
authors.forename: Daryl J
authors.initials: DJ
authors.lastname: Kor
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Winters
authors.forename: S Breanndan
authors.initials: SB
authors.lastname: Moore
authors.forename: Bekele
authors.initials: B
authors.lastname: Afessa
mesh_terms: D000368:Aged; D016913:Blood Component Transfusion / Q000009:adverse effects* / Q000379:methods*; D001782:Blood Donors; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D010949:Plasma; D017713:Platelet Transfusion / Q000009:adverse effects / Q000379:methods; D011659:Pulmonary Gas Exchange; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D012737:Sex Factors