The Studies About Transgender Blood Transfusion: Does It Affect Mortality?

Whenever a healthcare worker encounters an emergency blood transfusion, they will ensure that the blood donor matches the donor blood, but no one cares about the donor's gender. However, the latest research has questioned this. The study suggests that males who are less than 50 years old have a higher mortality rate when they receive blood from pregnant women. However, this conclusion and the mechanism behind it still need to be further confirmed.

Studies have shown that male patients have a higher mortality rate after receiving blood from pregnant women.
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Sex effects of blood transfusion?

For the first time, researchers from the Netherlands conducted a large-scale study on the relationship between gender and blood transfusion. Researchers want to know how blood from a pregnant donor's bloodstream can affect the health of a male blood donor. By counting the blood usage of 42,000 Dutch transfusions, they found that when red blood cells from pregnant donors were used in men who were younger than 50 years of age as compared to those who used red blood cells from the same-sex donor Men, who were 1.5 times more likely to die within three years of receiving blood transfusions, were not exposed to the same risks for men who used blood as men. The research was published on JAMA on Tuesday.

Both the scientists involved in the study and the American Red Cross think the study alone is not enough to have a material impact on current medical work, but if the finding is further substantiated in a follow-up study, it is likely to change The traditional way of matching blood transfusions is likely to prolong the lives of thousands of people who have blood worldwide. "If this finding is confirmed, it will have both biological and clinical implications," said Gustaf Edgren, an unattached associate professor of epidemiology. "We do There is a need to understand the mechanisms involved. In fact, some of the data we obtained did not exactly match this finding. In our study, the gender of the blood transfusion did not have any effect on the health of blood donors. "

Including another pilot study conducted by the same authors, four studies have found the relationship between survival and gender mismatch in blood recipients. Some studies have shown that gender mismatches can have an impact whether pregnant women are pregnant or not. Another study showed that women's blood from male donors also had adverse effects, and vice versa.

Not only that, "Although the teams that conducted these studies came from different countries and used different data sources and their findings were slightly different, their findings all point to the same conclusion that gender differences do indeed affect blood transfusion outcomes "Said Henrik Bjursten, a biology professor from Stockholm. Professor Justin himself is not the author of the JAMA paper, but he was involved in leading a study that found that female patients may have problems with male blood.

Mechanism is unknown

At present, it is not yet clear what the physiological mechanism behind this conclusion is. Scientists speculate that pregnant women with red blood cells may contain some of the immune factors that allow younger men to use blood to produce more rejection. The main point of this theory is that a woman who has given birth to a boy may have an antibody that binds to the protein produced by the male Y chromosome, which may be a normal immune response they produce during pregnancy. However, the new study fails to validate the hypothesis because researchers do not have access to gender data for descendants of female blood donors. Justin noted that there are other arguments that the immune system in men and women is somewhat different in nature or that men react to the RNA in the blood of women.

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Justin proposed that scientists need to find out the biological principle behind this problem and then observe through randomized controlled trials whether the blood donor's gender and blood donor's pregnancy will affect the blood-using person. "Personally, I think blood transfusions are gender-related, which means that at present, millions of lives are being threatened, and it is not difficult at the moment to add sex restrictions to blood transfusions, Are we really taking risks with the lives of patients compared to the safe and convenient route? "Bin Justin said.

Justin's own study shows that for men and women undergoing heart surgery, blood from a donor who is a heterosexual is also at risk. In this study, the average life expectancy of blood transfusion recipients was reduced by one year. At present, there are over 100 million blood transfusions in the world each year. Just imagine if 10 to 40 million of them will be harmful. This figure can not be ignored. "And that figure is still going up," he said.

Disputes in continue

It is still very difficult to finally confirm the impact of gender on blood transfusions. In randomized trials, for example, some randomized blood transfusion patients must receive blood from different blood donors in this experiment. This will undoubtedly lead to ethical issues when transgender blood transfusion problems have caused many questions. However, such experiments are necessary because there is often a loophole in the available data (such as data from the Dutch study group). "We do not know if the current figures are sufficient to answer this question," said Ritchard Cable, a chief technology officer at the American Red Cross. Maxime Desmarets, a public health doctor and epidemiologist at the University of Besançon in France, said French researchers are also preparing follow-up studies on related issues and his team believes that blood transfusion There are no gender issues in the process.

Mary O'Neill, the provisional chief medical officer of the American Red Cross, mentioned in an official statement that the study "needs further confirmation due to the existence of the opposite of the conclusion." She added: "As more research is needed to confirm this issue, we do not intend to change the current standard of blood donation and the way clinical transfusions are conducted. The ICRC will continue to monitor follow-up studies to ensure the availability of blood And the patient's blood safety. "

Six years ago, the Dutch research team conducted the first small-scale study of transgender blood transfusions. No one had ever thought of looking at the donor's pregnancy history before, said Dutch epidemiologist Rutger Middelburg. Unless the investigators know what factors are of concern, it is difficult to accurately detect the difference in mortality, he wrote in the email. "We found that simply looking at all patients in the data we got would make The effect of transfusional transfusions is diluted to undetectable, "he added," and we have to find the right patient population. "Nor can he explain why the team found only a reduction in survival in the younger men. He mentioned that it is also possible that the reason for the need for blood transfusions in young men is not the same as for older men, and that this difference leads to statistical differences that are not caused by the problem of red cells in women.

The data used in the study is not perfect, said Middelburg. First, the team used the transfusion records of patients many years ago, and the researchers were not sure about the pregnancy status of all female blood donors. Researchers removed those blood-using data that used both types of blood at the same time, and because men donated blood more frequently than women, the entire data set naturally tilted toward men. Although pregnant women accounted for less than 6% of donor blood donor data for this study, the final conclusions of the study are still statistically significant. "In short, we are very confident about our findings," said Middelburg.

He is still continuing his research, and hopes to get more research funding. "I plan next to learn more about the pregnancy history of a female donor and the cause of death of the donor," he said. "But there is still a lot of other relevant research support that comes with enough data to reach a definitive conclusion."

References used for text and images:

• https://www.capitalfm.co.ke/lifestyle/2017/06/14/today-is-world-blood-donor-day-10-facts-you-may-not-know/
• http://slideplayer.com/slide/8618126/
• https://www.scientificamerican.com/article/blood-boundaries-should-transfusions-be-matched-by-sex/
• https://www.rd.com/health/wellness/zika-virus-sex-pregnancy/
• https://en.wikipedia.org/wiki/Blood_transfusion

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