Blood products, by many measures, have evolved to be an extremely safe and fundamental part of hospital care. Moreover, they are a valuable resource that should be respected and safeguarded. In... Show moreBlood products, by many measures, have evolved to be an extremely safe and fundamental part of hospital care. Moreover, they are a valuable resource that should be respected and safeguarded. In this thesis, we studied the relation of donor and product characteristics with patient outcomes in detail. By using thorough epidemiological methods, we found that there are still causes for concern pertaining to donor characteristics and transfusion recipient outcomes. In all chapters, in addition to describing the results and the most relevant aspects for clinical transfusion practice, we extensively described study limitations, and in a number of chapters we acknowledge that methodological limitations preclude causal claims. It should be noted that the goal of the research included in this thesis is not to criticize the use of blood products as a whole. Rather, the continuous improvement of a therapy’s safety and effectivity for those in need of it is always justified, and is the ultimate target of the research described here. Show less
Valk, S.J.; Caram-Deelder, C.; Evers, D.; Vooght, K.M.K. de; Kerkhof, D. van de; Wondergem, M.J.; ... ; Bom, J.G. van der 2023
Background and ObjectivesDonor characteristics have been implicated in transfusion-related adverse events. Uncertainty remains about whether sex, and specifically pregnancy history of the blood... Show moreBackground and ObjectivesDonor characteristics have been implicated in transfusion-related adverse events. Uncertainty remains about whether sex, and specifically pregnancy history of the blood donor, could affect patient outcomes. Whether storage duration of the blood product could be important for patient outcomes has also been investigated, and a small detrimental effect of fresh products remains a possibility. Here, we hypothesize that fresh red blood cell products donated by ever-pregnant donors are associated with mortality in male patients.Materials and MethodsWe used data from a cohort study of adult patients receiving a first transfusion between 2005 and 2015 in the Netherlands. The risk of death after receiving a transfusion from one of five exposure categories (female never-pregnant stored ≤10 days, female never-pregnant stored >10 days, female ever-pregnant stored ≤10 days, female ever-pregnant stored >10 days and male stored for ≤10 days), compared to receiving a unit donated by a male donor, which was stored for >10 days (reference), was calculated using a Cox proportional hazards model.ResultsThe study included 42,456 patients who contributed 88,538 person-years in total, of whom 13,948 died during the follow-up of the study (33%). Fresh units (stored for ≤10 days) from ever-pregnant donors were associated with mortality in male patients, but the association was not statistically significant (hazard ratio 1.39, 95% confidence interval 0.97–1.99). Sensitivity analyses did not corroborate this finding.ConclusionThese findings do not consistently support the notion that the observed association between ever-pregnant donor units and mortality is mediated by blood product storage. Show less
