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. STUDY DESIGN AND 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.

Survival after blood transfusion.

BACKGROUND: Long-term survival of transfusion recipients has rarely been studied. This study examines short- and long-term mortality among transfusion recipients and reports these as absolute rates and rates relative to the general population. STUDY DESIGN AND METHODS: Population-based cohort study of transfusion recipients in Denmark and Sweden followed for up to 20 years after their first blood transfusion. Main outcome measure was all-cause mortality. RESULTS: A total of 1,118,261 transfusion recipients were identified, of whom 62.0 percent were aged 65 years or older at the time of their first registered transfusion. Three months after the first transfusion, 84.3 percent of recipients were alive. One-, 5-, and 20-year posttransfusion survival was 73.7, 53.4, and 27.0 percent, respectively. Survival was slightly poorer in men than in women, decreased with increasing age, and was worst for recipients transfused at departments of internal medicine. The first 3 months after the first transfusion, the standardized mortality ratio (SMR) was 17.6 times higher in transfusion recipients than in the general population. One to 4 years after first transfusion, the SMR was 2.1 and even after 17 years the SMR remained significantly 1.3-fold increased. CONCLUSION: The survival and relative mortality patterns among blood transfusion recipients were characterized with unprecedented detail and precision. Our results are relevant to assessments of the consequences of possible transfusion-transmitted disease as well as for cost-benefit estimation of new blood safety interventions.

False-reactive microbiologic screening test results in Swedish blood donors-how big is the problem? A survey among blood centers and deferred donors.

BACKGROUND: Screening of blood donors for markers of transfusion-transmissible infectious agents leads to a varying number of false-reactive test results and sometimes thereby temporary or permanent deferral of donors and also to loss of collected units. STUDY DESIGN AND METHODS: Data on false-reactive screening test results in 2002 and 2003 were collected from 19 blood centers in Sweden. A questionnaire was sent to donors deferred because of false-reactive screening test results to investigate their perception of the information and their reaction to the deferral. RESULTS: Testing of 21,189 samples from new donors and 423,543 donations from regular and/or repeat donors produced 1,059 false-reactive test results, mostly from hepatitis C virus antibody testing, and 299 deferrals. Six different human immunodeficiency virus tests led to between 0.02 and 0.2 percent false-reactive results. The deferral rate varied considerably between different counties. Of 204 deferred donors contacted, 180 (88%) answered the questionnaire. More than 80 percent were worried about their test results and worry was more common among those who did not feel sufficiently informed. CONCLUSION: The results imply that there is a need for a more standardized approach to the screening of blood donors and donations with the aim of minimizing the number of false-reactive screening test results. They also emphasize the importance of appropriate information and support to deferred donors.

Cumulative risks of early fresh frozen plasma, cryoprecipitate and platelet transfusion in Europe.

BACKGROUND: Injuries are a leading cause of death in the young. Of transfused patients in Sweden about 10% have injuries and 2% receive plasma and 0,2% platelets. Quality, safety, sufficiency and the optimal use of blood and blood components have been the focus for the Council of Europe since 1955 and Guidelines are published. In 2002 the European Community adopted the Directive 2002/98/EC with legally binding requirements for the quality and safety of blood and blood components, including hemovigilance systems. THE USE OF BLOOD COMPONENTS: Data on the use of blood components are regularly collected by the Council of Europe. The use per 1,000 inhabitants show wide variations. THE RISKS OF TRANSFUSION: The potential adverse effects of plasma and platelet components, listed in recently published monographs from the Council of Europe, have been compared with published data from hemovigilance systems. There are two principally different hemovigilance systems in Europe, and the reported overall rates show a fifty-fold difference. Severe transfusion reactions are rare or very rare. Transfusion related acute lung injury (TRALI) and sepsis due to inadvertent bacterial contamination are probably of particular inportance for trauma patients. These reactions are presumably insufficiently recognized and reported. CONCLUSION: Common definitions and systems for hemovigilance will be important for the evaluation of new safety measures. A commonly accepted definition of TRALI will aid in the differential diagnosis of transfusion reactions. Measures to further reduce the rate of transfusion reactions will render the risk-benefit ratio of appropiate transfusions more favorable.