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Restrictions On Female Plasma May Not Be Warranted

Fri, 02/12/2010 - 10:33am

Three years after the U.S. blood banking industry issued recommendations that discourage transfusing plasma from female donors because of a potential antibody reaction, Duke University Medical Center researchers discovered that female plasma actually may have advantages.

The Duke team conducted a retrospective study of Red Cross donor and hospital data from a period when female plasma wasn't restricted. They examined heart surgery outcomes for lung problems, and prolonged length of hospital stay or death. Cardiac surgery patients use about one-fifth of all transfused blood products.

They found that patients receiving female-donor plasma did significantly better than similar patients receiving male-donor plasma.

The 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, and the antibodies may form as a reaction to their fetus. The more pregnancies a woman has had, the greater the chance that she has these antibodies.

The AABB (formerly the American Association of Blood Banks) recommended in late 2006 that blood banks adopt measures to reduce the risk of TRALI, such as avoiding use of female donor plasma for transfusion due to the higher risk antibodies associated with TRALI.

Recipients of female-donor plasma had a lower incidence of pulmonary dysfunction (5.9 percent vs. 10.8 percent) and death within 30 days of surgery or hospitalization longer than 10 days (9 percent vs. 16.4 percent). The two groups had similar long-term survival rates.

The study did not specifically address the catastrophic lung problem, and the Duke study findings will need to be re-evaluated in prospective studies. There isn't enough data yet to support or refute the policy to exclude female-donor plasma as a way to avoid catastrophic TRALI.

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