Blood Transfusion Clinical Trial
Official title:
Pilot Study of Sex-matched vs. Sex-mismatched Red Blood Cell Transfusion
Blood transfusion is common for patients in hospital, especially for those in intensive care. Patients receive blood that is matched to them based on their blood group (A, B, AB, O), but not based on sex. This means male or female patients may receive male or female blood. There is some evidence to suggest that giving male patients female blood and female patients male blood (sex-mismatched blood) may be harmful. The investigators think giving males only male blood and females only female blood (sex-matched blood) will be better for the patients and improve their survival. To test this, the study team will randomly give 50% of intensive care patients who require blood only sex-mismatched blood and 50% of intensive care patients only sex-matched blood for their entire hospital stay. Then, health data of patients will be collected to see if either group does better after transfusion. Before this is done as a large study with thousands of patients, it will be attempted as a smaller pilot study with a few hundred patients to be sure the processes suggested make sense and are possible for hospitals and for the blood supplier to follow.
Blood transfusion is one of the most common procedures performed during hospitalization. Approximately 85 million red blood cell (RBC) units are transfused globally each year. RBC units are matched for blood groups but matching for other donor characteristics such as sex, is not considered. By the current standard of care, female or male patients can receive RBCs from male or female donors. However, accumulating data suggests that sex-mismatched transfusions may be harmful. Sex-mismatched transfusions and transplantations have been associated with poor outcomes. Plasma from female donors is associated with an increased risk of transfusion related acute lung injury (TRALI); sex-mismatched heart transplantation is associated with increased transplant-associated mortality; and stem cell transplants from female donors are associated with worse outcomes. Anemia is common during critical illness and 20-40% of critically ill patients require a mean of two to five RBC units during admission to the intensive care unit (ICU). Once a patient receives more than six RBC units, virtually all patients (>97%) will have received at least one sex-mismatched RBC. The population of transfused ICU adult patients is already at high risk of death, with a demonstrated 90-day all-cause mortality of 35-37% based on the ABLE study, and in-hospital mortality of 24-34% (institutional data). Thus, new supportive care strategies are needed to improve outcomes of this highly vulnerable patient group. Transfusion data linked to donor sex spanning a 6-year period was previously analyzed. Using a careful analysis that controlled for covariates and stratified on time-dependent and fixed variables, 25,219 transfusion recipients were retrospectively analyzed and a significant association between male to female RBC transfusions and death [hazard ratio (HR) 1.31, 95% confidence interval (CI) 1.02-1.69] was found. A trend towards higher mortality was also noted with female to male RBCs (HR 1.13: 95% CI 0.92-1.39), and with sex-mismatched vs. sex-matched RBCs overall (HR 1.23: 95% CI 1.04-1.45). These findings suggest that matching RBC transfusions for sex can reduce mortality in ICU patients. The investigators hypothesize that donor-recipient sex-matched RBC transfusions are associated with improved survival in hospital compared to sex-mismatched RBC transfusions. Sex-matched RBC transfusions may represent an important, readily implementable advance in supportive care of critically ill patients. ;
| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Active, not recruiting |
NCT03651154 -
Hypovolemic Phlebotomy to Reduce Blood Transfusions in Major Hepatic Resections
|
N/A | |
| Completed |
NCT01136590 -
Multicenter, Randomized Placebo-controlled Clinical Trial to Evaluate the Effect of Perioperative Use of Tranexamic Acid on Transfusion Requirements and Surgical Bleeding in Major Spine Surgery
|
Phase 4 | |
| Completed |
NCT00097006 -
Retrovirus Epidemiology Donor Study-II (REDS-II)
|
N/A | |
| Completed |
NCT00005303 -
Effectiveness of AIDS Antibody Screening
|
N/A | |
| Completed |
NCT00005319 -
Epidemiologic Studies of Blood Use in the United States - SCOR in Transfusion Medicine
|
N/A | |
| Completed |
NCT00005301 -
Transfusion Safety Study (TSS)
|
N/A | |
| Completed |
NCT00000581 -
Granulocyte Transfusion Study
|
Phase 3 | |
| Completed |
NCT04089865 -
Oral Versus Intravenous Tranexamic Acid
|
Phase 4 | |
| Completed |
NCT02968654 -
TRansfusion Strategies in Acute Brain INjured Patients
|
N/A | |
| Enrolling by invitation |
NCT06019364 -
Transfusion of Whole Blood in Acute Bleeding
|
||
| Completed |
NCT04911413 -
Comparison of Three Tranexamic Acid Dose Regimens in Patients Undergoing Cardiac Valve Surgery
|
Phase 4 | |
| Completed |
NCT03727230 -
RhD+ Blood Transfusion to Asian-type DEL Recipients
|
N/A | |
| Recruiting |
NCT06102590 -
Oxygen Extraction-guided Transfusion
|
N/A | |
| Completed |
NCT00400192 -
Transfusion-Associated Microchimerism in Individuals Receiving a Blood Transfusion After a Traumatic Injury
|
N/A | |
| Completed |
NCT00000593 -
Viral Activation Transfusion Study (VATS)
|
N/A | |
| Completed |
NCT05627544 -
Blood Transfusion Applications in Hip Replacements
|
||
| Completed |
NCT05581238 -
Validation of a Red Blood Cell Transfusion Prediction Model in a Low Transfusion Rate Population.
|
||
| Not yet recruiting |
NCT03429790 -
Cell Salvage During Caesarean Section (CSCS)
|
N/A | |
| Completed |
NCT00822588 -
Comparison in Need for Bank Blood Between Patients Undergoing Total Hip Surgery That Either Receive Their Own Blood Back or Not
|
N/A | |
| Withdrawn |
NCT00269971 -
A Study to Determine an Effective Dose of Epoetin Alfa to Decrease the Number of Units of Blood Required to be Transfused During Hip Replacement Surgery.
|
Phase 3 |