Post-transfusion mortality among recipients of ABO-compatible but non-identical plasma.
OBJECTIVE
The consequences of ABO-compatible non-identical plasma for patient outcome have not been studied in randomized clinical trials or large cohort studies and use varies widely in the absence of evidence-based policies. We investigated if transfusion with compatible instead of identical plasma confers any short-term survival disadvantage on the recipients.


METHODS
The cohort of all 86 082 Swedish patients who received their first plasma transfusion between 1990 and 2002 was followed for 14 days and the risk of death in patients exposed to compatible non-identical plasma compared to recipients of only identical plasma.


RESULTS
After adjustment for potential confounding factors, there was an increased mortality associated with exposure to ABO-compatible non-identical plasma, with the excess risk mostly confined to those receiving 5 or more units (relative risk, 1.15; 95% confidence interval, 1.02-1.29). Stratification by blood group indicated higher risks in group O recipients, especially when the compatible plasma was from a group AB donor.


CONCLUSIONS
This study suggests that ABO-compatible non-identical plasma is less safe than identical plasma. Subanalyses by blood group suggest a role for circulating immune complexes. Our findings may have policy implications for improving transfusion safety.
Shanwell
A
A
Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden.
Andersson
T M-L
TM
Rostgaard
K
K
Edgren
G
G
Hjalgrim
H
H
Norda
R
R
Melbye
M
M
Nyrén
O
O
Reilly
M
M
D000017:ABO Blood-Group System / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016913:Blood Component Transfusion / Q000401:mortality*; D001787:Blood Group Incompatibility / Q000276:immunology; D001804:Blood Transfusion, Autologous / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000276:immunology*; D012044:Regression Analysis; D012306:Risk; D055815:Young Adult
D000017:ABO Blood-Group System