FemaleDonorPlasmaHavewemadeaterriblemistake女性供体血浆中我们做了一个可怕的错误

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1、FemaleDonorPlasma:Havewemadeaterriblemistake?ShuenTanTMRJournalClubMarch2,2010BackgroundTRALInotfullyunderstood2formsexist:Immune-mediated:anti-HLA,anti-HNANonimmune-mediated:neutrophilpriming#1causeoftransfusion-relatedmortalityAllbloodproductsbutespeciallyhighplasma-volumecomponentsThempeskymulti

2、parouswomen!Wheredidallthewomengo?UKSHOT(AABB2006)StrongassociationbetweenTRALIandplasma/platelettransfusionFrequentlyassociatedwithleukocyteab’sNoTRALIassociatedwithmaledonorsAnti-HLAin1/7offemales,increasingwithparityFemaleplt/plasmadonorsexcluded2003“Highlylikely”TRALIcases:16in2003,3in2005Meanw

3、hile,acrossthePond…CanadianConsensusConferencegivesusacommondefinition(2004)AABBrecommendsTRALIriskreductionmeasuresin2006October2007:CBSstartspreferentiallyusingmaleplasmafortransfusionBuffycoatbeginsJuly2009:Wewavegood-byetomultiparouspltpheresisdonorsWelsbyIJetal.Therelationshipofplasmatransfusi

4、onfromfemaleandmaledonorswithoutcomeaftercardiacsurgery.JThoracCardiovascSurg2010:epub.MethodsStudyTypeRetrospectivecohortPlaceDukeUniversityMedicalCenter(singlecentre)PatientsAdult,primary,non-emergency,CABGsurgeryTimeJune1,1995-June30,2002“precedingconcernsregardingdonorgender”MethodsExtractedpai

5、redsubsetsofpatientsreceivingexclusivelymaleorfemaleplasmaMatchedfornumberofplasmaunitsandnearestsurgerydateOtherplasmaproductsnotmatchedPlasmaunitscross-matchedwithARCtofinddonorcharacteristicsOutcomesPrimaryoutcomePulmonarydysfunction:compositeofpulmonaryedema,pneumonia,andARDSNotspecificallyTRAL

6、ISecondaryoutcomesDeathwithin30daysProlongedhospitalstayLong-termsurvivalOtherpost-opcomplications(STScriteria)ResultsPrimaryOutcomeLesscommoninrecipientsoffemaleplasma5.9%vs.10.8%,p=0.01SecondaryOutcomesDeath/prolongedhospitalstaylesscommoninrecipientsoffemaleplasma9%vs.16.4%,p=0.002Long-termsurvi

7、valnodifferentwhenadjustedfordifferences,p=0.47Fewerinfectiouscomplications1%vs.4%,p=0.01SecondaryanalysesAllplasmarecipients(n=2157)Complicationsvs.likelihoodofreceivingmaledonorplasmaPulmonarydysfunctiona