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

Erythrocyte Transfusion / adverse effects Female Humans Male Observational Studies as Topic Randomized Controlled Trials as Topic Sex Factors
blood safety donors transfusion medicine (in general)

Journal

Vox sanguinis
ISSN: 1423-0410
Titre abrégé: Vox Sang
Pays: England
ID NLM: 0413606

Informations de publication

Date de publication:
Jul 2019
Historique:
received: 11 12 2018
revised: 22 02 2019
accepted: 01 04 2019
pubmed: 28 5 2019
medline: 18 10 2019
entrez: 25 5 2019
Statut: ppublish

Résumé

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. 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. 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. 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.

Sections du résumé

BACKGROUND AND OBJECTIVES OBJECTIVE
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 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 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 CONCLUSIONS
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.

Identifiants

DOI: 10.1111/vox.12783 PMID: 31124172
pubmed: 31124172
doi: 10.1111/vox.12783
doi:

Types de publication

Journal Article Meta-Analysis Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

505-516

Informations de copyright

© 2019 International Society of Blood Transfusion.

Auteurs

Michelle P Zeller (MP)

McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.
Canadian Blood Services, Medical Office, Hamilton, ON, Canada.
Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada.
ORCID: 0000-0002-6489-6980

Bram Rochwerg (B)

Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.

Erin Jamula (E)

McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.

Na Li (N)

McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.

Christopher Hillis (C)

McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.
Department of Oncology, McMaster University, Hamilton, ON, Canada.

Jason P Acker (JP)

Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.
Centre for Innovation, Canadian Blood Services, Edmonton, AB, Canada.

Ryan J R Runciman (RJR)

McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.

Shannon J Lane (SJ)

McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.

Naveen Ahmed (N)

McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.

Donald M Arnold (DM)

McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.
Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada.

Nancy M Heddle (NM)

McMaster Centre for Transfusion Research, McMaster University, Hamilton, ON, Canada.
Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada.

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Classifications MeSH

questionsmedicales.fr › Thérapeutique › Biothérapie › Transfusion sanguine › Transfusion de composants du sang › Transfusion d'érythrocytes › Sex-mismatched red blood cell transfusions and...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Sex-mismatched red blood cell transfusions and...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études cliniques comme sujet › Études observationnelles comme sujet › Sex-mismatched red blood cell transfusions and...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études cliniques comme sujet › Essais cliniques comme sujet › Essais cliniques contrôlés comme sujet › Essais contrôlés randomisés comme sujet › Sex-mismatched red blood cell transfusions and...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Facteurs épidémiologiques › Facteurs sexuels › Sex-mismatched red blood cell transfusions and...