Sex-mismatched red blood cell transfusions and mortality: A systematic review and meta-analysis

Michelle P Zeller; Bram Rochwerg; Erin Jamula; Na Li; Christopher Hillis; Jason P Acker; Ryan J R Runciman; Shannon J Lane; Naveen Ahmed; Donald M Arnold; Nancy M Heddle

doi:10.1111/vox.12783

Sex-mismatched red blood cell transfusions and mortality: A systematic review and meta-analysis

Vox Sang. 2019 Jul;114(5):505-516. doi: 10.1111/vox.12783. Epub 2019 May 23.

Authors

Michelle P Zeller^{1

2

3}, Bram Rochwerg^{4

5}, Erin Jamula¹, Na Li¹, Christopher Hillis^{1

6}, Jason P Acker^{7

8}, Ryan J R Runciman¹, Shannon J Lane¹, Naveen Ahmed¹, Donald M Arnold^{1

3}, Nancy M Heddle^{1

3}

Affiliations

¹ McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.
² Canadian Blood Services, Medical Office, Hamilton, ON, Canada.
³ Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁴ Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁵ Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.
⁶ Department of Oncology, McMaster University, Hamilton, ON, Canada.
⁷ Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.
⁸ Centre for Innovation, Canadian Blood Services, Edmonton, AB, Canada.

PMID: 31124172
DOI: 10.1111/vox.12783

Abstract

Background and objectives: Selection of a compatible red blood cell (RBC) unit does not include matching for donor sex. This systematic review and meta-analysis aims to summarize the evidence examining the impact of sex-mismatched RBC transfusion on recipient mortality.

Materials and methods: Ovid MEDLINE, Ovid EMBASE, CINAHL, PubMed, Web of Science and the Cochrane Database of Systematic Reviews were searched from inception up to 23 November 2018. Randomized controlled trials and observational studies were included in the search. Eligible studies reported on the impact of sex-matched compared to sex-mismatched RBC transfusion on recipient mortality. Two investigators independently extracted data and assessed study quality. A three-level meta-analytic model was applied to emphasize the unknown dependence among the effect sizes.

Results: Five retrospective observational studies (n = 86 737) were included; no RCTs were found. Sex-mismatched RBC transfusions were associated with a higher risk of death compared with sex-matched transfusions (pooled hazard ratio [HR]: 1·13; 95% confidence interval [CI]: 1·02-1·24). In the subgroup of cardiovascular surgery (n = 57 712), there was no significant increase in mortality with sex-mismatched transfusions (pooled HR: 1·08; 95% CI: 0·95-1·22). The data were prone to confounding, selection bias and reporting bias. Certainty of the evidence was very low.

Conclusion: Sex-mismatched RBC transfusions were associated with an increased risk of death in this pooled analysis. However, the certainty of the evidence was very low from observational studies. The need to match donor and recipient sex for transfusions requires further investigation because of the potential widespread impact.

Keywords: blood safety; donors; transfusion medicine (in general).

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Erythrocyte Transfusion / adverse effects
Erythrocyte Transfusion / mortality*
Female
Humans
Male
Observational Studies as Topic
Randomized Controlled Trials as Topic
Sex Factors