Should plasma from female donors be avoided? A population-based cohort study of plasma recipients in Sweden from 1990 through 2002.
BACKGROUND
Plasma from female donors has been implicated in the sometimes fatal complication known as transfusion-related acute lung injury. In studies of patients in intensive care units, worsened gas exchange of the lungs has also been attributed to female plasma. Despite a lack of population-based evidence, policies have already been introduced to exclude female donor plasma.


METHODS
Short-term mortality after plasma transfusion was investigated using data from the Scandinavian Donations and Transfusions (SCANDAT) database. A cohort of 92,565 patients in 30 Swedish hospitals were followed for 14 days after their first plasma transfusion. The relative risk (RR) of death in recipients of female plasma compared to recipients of only male plasma was estimated from Poisson regression.


RESULTS
Recipients had median age 70 years, received a mean of 4.4 plasma units, and had an overall 14-day mortality of 8.43%. Sixty-eight percent were exposed to female plasma, with a 14-day mortality of 8.85% compared to 7.53% in the nonexposed group. After adjustment for potential confounding factors, the RRs were 1.16 (confidence interval [CI], 1.06-1.27) and 1.32 (CI, 1.17-1.49) for those receiving 3 to 4 and 5 or more units of female plasma, respectively. Risk estimates were increased in an analysis of deaths with a concomitant discharge diagnosis involving the respiratory or circulatory system or an adverse reaction.


CONCLUSIONS
This large population-based cohort study of unselected patients suggests that transfusion of plasma from female donors confers a short-term survival disadvantage on recipients.
Tynell
Elsa
E
Department of Infectious Diseases and Transfusion Medicine, Karolinska University Hospital, and Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden.
Andersson
Therese M L
TM
Norda
Rut
R
Edgren
Gustaf
G
Nyren
Olof
O
Shanwell
Agneta
A
Reilly
Marie
M
D055371:Acute Lung Injury / Q000209:etiology / Q000401:mortality*; D000368:Aged; D016913:Blood Component Transfusion / Q000401:mortality*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D010949:Plasma; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013548:Sweden; D013997:Time Factors