Restrictions on Female Plasma May Be Unwarranted

In contrast to recommendations issued in 2006 discouraging the transfusion of plasma from female donors, due to a potential antibody reaction, a new study claims that female plasma may actually have advantages.

Researchers at Duke University Medical Center (Duke; Durham, NC, USA) and the University of Alabama (Tuscaloosa, USA) conducted a retrospective study of America Red Cross (Washington, DC, USA) donor and hospital data on 2,157 cardiac surgery candidates who received plasma perioperatively from only female donors, and compared them with male-only recipients who were matched for the number of units transfused and surgery date.

The results showed that from the 1,069 recipients receiving plasma exclusively from female or male donors, 390 matched pairs were identified. Recipients of female plasma had a lower incidence of pulmonary dysfunction (5.9%) compared to male donor (10.8%), and death or hospitalization for more than 10 days was also lower (9% compared 16.4%); long-term survivals rates, however, were similar in both groups, but escalating plasma transfusion was associated with increased 30-day mortality. The results also showed that there were no blood bank-reported complications. The study was published in the February 2010 issue of the Journal of Thoracic and Cardiovascular Surgery.

"We were very surprised by the results, because when we began the study, we expected to see data that supported the idea that female-donor plasma would be riskier,” said senior author professor of anesthesiology Mark Stafford-Smith. M.D. of Duke University. "In fact, we found just the opposite. At first, we thought we might have switched our data somehow, but careful reexamination confirmed that recipients of male-donor plasma had worse outcomes.”

The 2006 recommendations to restrict plasma transfusions were based on evidence tying female-donor plasma to a serious lung injury called transfusion-related acute lung injury (TRALI). Antibodies that may cause TRALI are more common in women who have been pregnant, possibly forming as a reaction to their fetus; the more pregnancies a woman has had, the greater the chance that she has these antibodies. As a result, the American Association of Blood Banks (AABB; Bethesda, MD, USA) recommended that blood banks adopt measures to reduce the risk of TRALI, including avoiding use of female donor plasma for transfusion.

Related Links:
Duke University Medical Center
University of Alabama
America Red Cross
American Association of Blood Banks