The Effect of Sex-Mismatched Red Blood Cell Transfusion on Endothelial Cell Activation in Critically Ill Patients

• Published in: Transfusion medicine and hemotherapy Vol. 49; no. 2; pp. 98 - 106
• Main Authors: Alshalani, Abdulrahman, van Manen, Lisa, Boshuizen, Margit, van Bruggen, Robin, Acker, Jason P., Juffermans, Nicole P.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01-04-2022
• Subjects: Blood donors; Endothelium; Ethylenediaminetetraacetic acid; Health aspects; Interleukins; Medical research; Medicine, Experimental; Mortality; Netherlands; Research Article; United Kingdom; Von Willebrand factor; United Kingdom; Netherlands; Sex-mismatched transfusion; Red blood cell; Transfusion outcomes; Endothelial activation; Critically ill patients; Blood donor
• ISSN: 1660-3796; 1660-3818
• DOI: 10.1159/000520651

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 (T 0 ), 1 h after (T 1 ), and 24 h after transfusion (T 24 ) 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 T 24 (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 T 24 (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.