TY - JOUR
T1 - The Effect of Sex-Mismatched Red Blood Cell Transfusion on Endothelial Cell Activation in Critically Ill Patients
AU - Alshalani, Abdulrahman
AU - van Manen, Lisa
AU - Boshuizen, Margit
AU - van Bruggen, Robin
AU - Acker, Jason P.
AU - Juffermans, Nicole P.
N1 - Funding Information: The authors would like to thank statisticians at the division of Statistics Consultation, the Department of Epidemiology and Data Science-Methodology at Amsterdam UMC for their help in verifying the statistical analyses. We would also like to acknowledge the staff of Sanquin and the blood banks of Amsterdam UMC for their help in retrieving blood donor information. Abdulrahman Alshalani is supported by the King Saud University and the Saudi Arabian Cultural Bureau in the Netherlands. Publisher Copyright: © 2021 The Author(s). Published by S. Karger AG, Basel.
PY - 2022
Y1 - 2022
N2 - Background: Observational studies suggest that sex-mismatched transfusion is associated with increased mortality. Mechanisms driving mortality are not known but may include endothelial activation. The aim of this study is to investigate the effects of sex-mismatched red blood cell (RBC) transfusions on endothelial cell activation markers in critically ill patients. Study Design and Methods: In patients admitted to the intensive care unit who received a single RBC unit, blood samples were drawn before (T0), 1 h after (T1), and 24 h after transfusion (T24) for analysis of soluble syndecan-1, soluble intercellular adhesion molecule-1, soluble thrombomodulin (sTM), von Willebrand factor antigen, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNFα). Changes in the levels of these factors were compared between sex-matched and sex-mismatched groups. Results: Of 69 included patients, 32 patients were in the sex-matched and 37 patients were in the sex-mismatched group. Compared to baseline, sex-matched transfusion was associated with significant reduction in sTM level (p value = 0.03). Between-group comparison showed that levels of syndecan-1 and sTM were significantly higher in the sex-mismatched group compared to the sex-matched group at T24 (p value = 0.04 and 0.01, respectively). Also, TNFα and IL-6 levels showed a statistically marginal significant increase compared to baseline in the sex-mismatched group at T24 (p value = 0.06 and 0.05, respectively), but not in the sex-matched group. Discussion: Transfusion of a single sex-mismatched RBC unit was associated with higher syndecan-1 and sTM levels compared to transfusion of sex-matched RBC unit. These findings may suggest that sex-mismatched RBC transfusion is associated with endothelial activation.
AB - Background: Observational studies suggest that sex-mismatched transfusion is associated with increased mortality. Mechanisms driving mortality are not known but may include endothelial activation. The aim of this study is to investigate the effects of sex-mismatched red blood cell (RBC) transfusions on endothelial cell activation markers in critically ill patients. Study Design and Methods: In patients admitted to the intensive care unit who received a single RBC unit, blood samples were drawn before (T0), 1 h after (T1), and 24 h after transfusion (T24) for analysis of soluble syndecan-1, soluble intercellular adhesion molecule-1, soluble thrombomodulin (sTM), von Willebrand factor antigen, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNFα). Changes in the levels of these factors were compared between sex-matched and sex-mismatched groups. Results: Of 69 included patients, 32 patients were in the sex-matched and 37 patients were in the sex-mismatched group. Compared to baseline, sex-matched transfusion was associated with significant reduction in sTM level (p value = 0.03). Between-group comparison showed that levels of syndecan-1 and sTM were significantly higher in the sex-mismatched group compared to the sex-matched group at T24 (p value = 0.04 and 0.01, respectively). Also, TNFα and IL-6 levels showed a statistically marginal significant increase compared to baseline in the sex-mismatched group at T24 (p value = 0.06 and 0.05, respectively), but not in the sex-matched group. Discussion: Transfusion of a single sex-mismatched RBC unit was associated with higher syndecan-1 and sTM levels compared to transfusion of sex-matched RBC unit. These findings may suggest that sex-mismatched RBC transfusion is associated with endothelial activation.
KW - Blood donor
KW - Critically ill patients
KW - Endothelial activation
KW - Red blood cell
KW - Sex-mismatched transfusion
KW - Transfusion outcomes
UR - http://www.scopus.com/inward/record.url?scp=85120912135&partnerID=8YFLogxK
U2 - https://doi.org/10.1159/000520651
DO - https://doi.org/10.1159/000520651
M3 - Article
C2 - 35611381
SN - 1660-3796
VL - 49
SP - 98
EP - 105
JO - Transfusion Medicine and Hemotherapy
JF - Transfusion Medicine and Hemotherapy
IS - 2
ER -