Sex-mismatch

Background

Our group has previously found that sex-mismatch (males patients receiving blood from female donors and female patients receiving blood from male donors) increases recipient mortality (Middelburg, et al. 2011). In the present project we aim to confirm or refute these findings in an independent larger cohort.

Rationale

The primary objectives of Sanquin Blood Supply include stimulating the safe and effective use of blood products and performing research that will help to reach this objective. If a true effect of donor sex-mismatch on recipient mortality is confirmed, this should lead to a change in donor-recipient matching strategies and logistics, leading to further optimization of the safe and effective use of blood products.

Methodology

We are performing a study based on data recorded in existing databases from several hospitals in the Netherlands. Hospitals provide data on all blood transfusions (red cells, plasma and platelets) and on characteristics of the patients who received those transfusions. Through the unit identification number these data are then linked to the donor and donation data from the Sanquin Blood Supply. The primary outcome is mortality within 90 days. 
Sex-mismatched transfusions, measured both as cumulative absolute number and as proportion of all transfusions are compared to sex-matched transfusions. The effect on mortality is estimated using time-varying cox regression. This analysis method allows modelling the relation between exposure (sex-mismatch), outcome (mortality), and confounders (total number of transfusions, year of transfusion, ABO and Rh blood type, sex of the patient, and hospital) taking into account that exposure and confounders vary over time.

Research Staff 

• Johanna (Anske) van der Bom^1,2,3
• Camila Caram-Deelder^1,2,3
• Rutger Middelburg^1,2,3

1. Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands 
2. Jon J van Rood Center for Clinical Transfusion Research, Sanquin-Leiden University Medical Center, Leiden, The Netherlands 
3. Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands

Collaborators

• Bert Mesman¹ 
• Jaap Jan Zwaginga^2,3,4
• Jan Molenaar⁵
• Karen MK de Vooght⁶
• Karen van Brussel^2,3,7
• Saskia le Cessie^7,8
• Saurabh Zalpuri^2,3,7
• Daan van de Kerkhof⁹
• Otto Visser¹⁰

1. CD-I Sanquin, Utrecht 
2. Jon J van Rood Center for Clinical Transfusion Research, Sanquin-Leiden University Medical Center, Leiden, The Netherlands 
3. Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands 
4. Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
5. Medische Administratie - Leiden University Medical Centre, Leiden, The Netherlands 
6. Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
7. Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
8. Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
9. Clinical Laboratory, Catharina Hospital, Eindhoven, the Netherlands 
10. Department of Haematology, VU University Medical Center, Amsterdam, The Netherlands

Reference

Caram-Deelder C, Kreuger AL, Evers D, de Vooght KMK, van de Kerkhof D, Visser O, Péquériaux NCV, Hudig F, Zwaginga JJ, van der Bom JG, Middelburg RA. Association of Blood Transfusion From Female Donors With and Without a History of Pregnancy With Mortality Among Male and Female Transfusion Recipients. JAMA. 2017;318(15):1471–1478. doi:10.1001/jama.2017.14825

Middelburg RA, Briët E, van der Bom JG. Mortality after transfusions, relation to donor sex. Vox Sanguinis 2011; 101:221–229. doi: 10.1111/j.1423-0410.2011.01487.x.