Database Studies

Omics –Donor Genetics and RBC Recipient Clinical Outcomes

Using public use datasets from REDS-III, this study analyzes blood donor and blood component data linked to patients who received single-unit red blood cell (RBC) transfusions, to better understand the effects of specific donor genetic variants and in vitro measures of oxidative/osmotic hemolysis on RBC transfusion efficacy. Outcome measures of RBC transfusion efficacy are defined as changes in hemoglobin, bilirubin, or creatinine at defined time periods following transfusion. Adjusting for donor, component, and recipient characteristics, such as donor and recipient demographics, donor ancestry, and component storage length and additive solution, we are assessing a priori defined donor SNPs, polygenic risk scores, and in vitro measures of osmotic and oxidative hemolysis in multivariable linear regression models of the above outcomes of transfusion efficacy.

Epidemiology of Pediatric Transfusion Practices

This database study of pediatric patients including neonates utilizes public use datasets collected during REDS-III. The goals of the study are 1) to estimate the incidence of blood transfusion, 2) investigate mortality in encounters with and without transfusion, 3) quantify pre-transfusion hematologic thresholds for transfusion, and 4) describe and evaluate the blood products received by children. The study analyzes neonates separately from other pediatric patients, at their birth encounter. All analyses are stratified by demographic characteristics and diagnoses of interest. For birth encounters, transfusion practice is analyzed by gestational age and week of life. Differences in transfusion practices by hospitals are also explored.

Clinical Impact of ABO Matching for Platelet and Plasma Transfusions

Transfusions of ABO non-identical plasma and platelets have previously been reported to produce adverse clinical effects. ABO incompatibility can be characterized as major incompatibility when transfused platelets and soluble plasma glycoproteins express ABO antigens that are recognized by anti-ABO antibodies in recipient plasma, or minor incompatibility when the transfused plasma contains anti-ABO antibodies that recognize recipient ABO glycoproteins. In both cases, some studies have shown soluble and cell surface immune complexes have been associated with potentially deleterious clinical effects.

This database study will analyze transfusion recipients in the publicly available REDS-III database to determine whether transfusion of ABO non-identical platelets and plasma is associated with adverse patient outcomes such as sepsis, thrombosis, increased frequency of platelet transfusions, and death. Due to the time-varying nature and cumulative effect of ABO non-identical transfusions, appropriate statistical methods will be used to account for these effects in survival and mixed effects models. Results will better inform platelet and plasma transfusion practice and may lead to changes in the future.