Dataset Information

Retrospective cohort studies of repeat donors reveal donor-dependent variability in the recovery of transfused platelets.

ABSTRACT:

Background

The in vivo recovery of transfused platelets is variable and often unpredictable. Although many recipient-dependent factors are well described, donor-dependent variables remain poorly understood.

Study design and methods

To explore donor-dependent variables we conducted 2 retrospective studies of platelet transfusion outcomes in repeat donors. One study analyzed multiple autologous, radiolabeled platelet transfusions, and a second study analyzed multiple clinical platelet transfusions from a small cohort of repeat donors.

Results

In 36 subjects, multiple within-subject determinations of recovery and survival of radiolabeled autologous platelets revealed a relative consistency in platelet recoveries within donors compared to the range of recoveries among donors. Intraclass correlation coefficients for platelet recovery were 43% to 93%. In 524 ABO-compatible clinical platelet transfusions derived from seven donors, a linear mixed-effects model revealed significant donor-dependent differences in corrected count increments for units stored for 4 or 5 days.

Conclusions

These two studies indicate reproducible donor-dependent differences in transfused platelet recovery, suggesting a possible heritable influence on the quality of transfused platelets.

SUBMITTER: Stefely JA

PROVIDER: S-EPMC8103892 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Publications

Retrospective cohort studies of repeat donors reveal donor-dependent variability in the recovery of transfused platelets.

Stefely Jonathan A JA Gailey Michael M Knudson Michael M Dumont Larry J LJ Raife Thomas J TJ Samia Noelle I NI

Transfusion 20200601 8

<h4>Background</h4>The in vivo recovery of transfused platelets is variable and often unpredictable. Although many recipient-dependent factors are well described, donor-dependent variables remain poorly understood.<h4>Study design and methods</h4>To explore donor-dependent variables we conducted 2 retrospective studies of platelet transfusion outcomes in repeat donors. One study analyzed multiple autologous, radiolabeled platelet transfusions, and a second study analyzed multiple clinical platel ...[more]

PMID: 32483843

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Project description:BackgroundObservational studies determining the effect of red blood cell (RBC) donor sex on recipient mortality have been inconsistent. Emulating hypothetical randomized target trials using large real-world data and targeted learning may clarify potential adverse effects.MethodsIn this retrospective cohort study, a RBC transfusion database from the Capital Region of Denmark comprising more than 900,000 transfusion events defined the observational data. Eligible patients were minimum 18 years, had received a leukocyte-reduced RBC transfusion, and had no history of RBC transfusions within the past year at baseline. The doubly robust targeted maximum likelihood estimation method coupled with ensembled machine learning was used to emulate sex-stratified target trials determining the comparative effectiveness of exclusively transfusing RBC units from either male or female donors. The outcome was all-cause mortality within 28 days of the baseline-transfusion. Estimates were adjusted for the total number of transfusions received on each day k, hospital of transfusion, calendar period, patient age and sex, ABO/RhD blood group of the patient, Charlson comorbidity score, the total number of transfusions received prior to day k, and the number of RBC units received on each day k from donors younger than 40 years of age.FindingsAmong 98,167 adult patients who were transfused between Jan. 1, 2008, and Apr. 10, 2018, a total of 90,917 patients (54.6% female) were eligible. For male patients, the 28-day survival was 2.06 percentage points (pp) (95 % confidence interval [CI]: 1.81-2.32, P<0.0001) higher under treatment with RBC units exclusively from male donors compared with exclusively from female donors. In female patients, exclusively transfusing RBC units from either male or female donors increased the 28-day survival with 0.64pp (0.52-0.76, P<0.0001), and 0.62pp (0.49-0.75, P<0.0001) compared with the current practice, respectively. No evidence of a sex-specific donor effect was found for female patients (0.02pp [-0.18-0.22]). The sensitivity analyses showed that a large unknown causal bias would have to be present to affect the conclusions.InterpretationThe results suggest that a sex-matched transfusion policy may benefit patients. However, a causal interpretation of the findings relies on the assumption of no unmeasured confounding, treatment consistency, positivity, and minimal model misspecifications.FundingNovo Nordisk Foundation and the Innovation Fund Denmark.

Project description:Rationale & objectiveLive kidney donation is associated with a small increased risk for kidney disease and hypertension in African American donors. We investigated a possible association between donor family history of end-stage kidney disease (ESKD) and their postdonation kidney function and the development of hypertension. We tested whether this association was modified by kidney donation.Study designRetrospective cohort.Setting & participantsFormer African American live kidney donors between 1993 and 2010. Healthy nondonors were selected from the Coronary Artery Disease in Young Adults (CARDIA) Study.ExposureFamily history of ESKD in a first-degree relative.OutcomesKidney function and blood pressure ≥ 140/90 mm Hg or use of antihypertensive medications at follow-up.Analytical approachDonors were grouped based on family history of ESKD. Outcomes were first compared between donor groups and then between donors and healthy nondonors matched for demographics, follow-up time, and family history. A mixed-effect model was used to compare outcomes.ResultsOf 179 donors, 139 (78%) had a first degree relative with ESKD. Predonation characteristics were similar between the 2 groups. At a median follow-up of 11 years postdonation, there was no difference in postdonation estimated glomerular filtration rates (68 ± 19 vs 69 ± 13 mL/min/1.73 m2; P = 0.71) and the presence of albuminuria (P = 0.16). There was a trend toward a higher incidence of hypertension (51% vs 35%; P = 0.08) among donors with a family history of ESKD than for those without. Although there was no difference in annual change in estimated glomerular filtration rate (P = 0.17), the risk for hypertension was higher in donors than nondonors (relative risk, 2.44 [95% CI, 1.56-3.84]), but there was no interaction by family history (P = 0.11).LimitationsRetrospective small study. Lack of data across donor-recipient specific biological relationship.ConclusionsFamily history of ESKD is not associated with postdonation kidney function among African American kidney donors. Live kidney donation is associated with an increased risk for hypertension among African Americans, independent of donor family history of ESKD.

Project description:BackgroundThere is no replacement for blood, and patients requiring transfusion depend on human donors, most of whom are family donors. Family donors may deny engagement in high-risk activities, which threaten the safety of donated blood. This study determined frequency of self-reported high-risk behaviors among replacement donors.MethodsThis retrospective study recruited 1317 donor records from 2017-2020, at Mankranso Hospital, Ghana. Data from archived donor questionnaires were extracted and analyzed with SPSS and GraphPad. Frequencies, associations, and quartiles were presented.ResultsThe donors were predominantly males (84.4%), 17-26 years old (43.7%), informal workers (71.8%), rural inhabitants (56.5%), first-time (65.0%), and screened in the rainy season (56.3%). Donation frequency was significantly associated with age, sex, occupation, and residence. Repeat donors were significantly older (p≤0.001). More males than females were deferred (p = 0.008), drug addicts (p = 0.001), had body modifications (p = 0.025), multiple sexual partners (p = 0.045), and STIs (p≤0.001), whereas, more females were recently treated (p = 0.044). Weight loss (p = 0.005) and pregnancy (p = 0.026) were frequent among 17-26-year group, whereas, tuberculosis was frequent among 37-60-year group (p = 0.009). More first-time donors were unwell (p = 0.005), deferred (p≤0.001), pregnant (p = 0.002), drug addicts, had impending rigorous activity (p = 0.037), body modifications (p = 0.001), multiple sexual partners (p = 0.030), and STIs (p = 0.008). STIs were frequent in the dry season (p = 0.010). First-time donors had reduced hemoglobin (p = 0.0032), weight (p = 0.0003), and diastolic pressure (p = 0.0241).ConclusionDonation frequency was associated with age, sex, occupation, and residence, with first-time donors younger than repeat donors. Deferral from donation, drug addiction, body modification, multiple sexual partners, and STIs were frequent among males, whereas, more females received treatment. Tuberculosis was frequently reported among older adults, whereas, weight loss and pregnancy were frequent among younger individuals. More first-time donors reported being unwell, deferred, drug addiction, body modifications, multiple sexual partners, STIs, and pregnant. Hemoglobin, weight, and diastolic BP were reduced among first-time donors.

Dataset Information

Retrospective cohort studies of repeat donors reveal donor-dependent variability in the recovery of transfused platelets.

Background

Study design and methods

Results

Conclusions

Publications

Retrospective cohort studies of repeat donors reveal donor-dependent variability in the recovery of transfused platelets.

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