Female Donor Plasma Have we made a terrible mistake女性供体血浆中我们做了一个可怕的错误.pptVIP

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Female Donor Plasma Have we made a terrible mistake女性供体血浆中我们做了一个可怕的错误.ppt

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Female Donor Plasma Have we made a terrible mistake女性供体血浆中我们做了一个可怕的错误

Female Donor Plasma: Have we made a terrible mistake? Shuen Tan TMR Journal Club March 2, 2010 Background TRALI not fully understood 2 forms exist: Immune-mediated: anti-HLA, anti-HNA Nonimmune-mediated: neutrophil priming #1 cause of transfusion-related mortality All blood products but especially high plasma-volume components Them pesky multiparous women! Where did all the women go? UK SHOT (AABB 2006) Strong association between TRALI and plasma/platelet transfusion Frequently associated with leukocyte ab’s No TRALI associated with male donors Anti-HLA in 1/7 of females, increasing with parity Female plt/plasma donors excluded 2003 “Highly likely” TRALI cases: 16 in 2003, 3 in 2005 Meanwhile, across the Pond… Canadian Consensus Conference gives us a common definition (2004) AABB recommends TRALI risk reduction measures in 2006 October 2007: CBS starts preferentially using male plasma for transfusion Buffy coat begins July 2009: We wave good-bye to multiparous plt pheresis donors Welsby IJ et al. The relationship of plasma transfusion from female and male donors with outcome after cardiac surgery. J Thorac Cardiovasc Surg 2010: epub. Methods Study Type Retrospective cohort Place Duke University Medical Center (single centre) Patients Adult, primary, non-emergency, CABG surgery Time June 1, 1995 - June 30, 2002 “preceding concerns regarding donor gender” Methods Extracted paired subsets of patients receiving exclusively male or female plasma Matched for number of plasma units and nearest surgery date Other plasma products not matched Plasma units cross-matched with ARC to find donor characteristics Outcomes Primary outcome Pulmonary dysfunction: composite of pulmonary edema, pneumonia, and ARDS Not specifically TRALI Secondary outcomes Death within 30 days Prolonged hospital stay Long-term survival Other post-op complications (STS criteria) Results Primary Outcome Less common in recipients of female plasma 5.9% vs. 10.8%, p=0.01 Secondary Outcomes Death/prol