The association of donor and recipient sex on sepsis rates and hemoglobin increment among critically ill patients receiving red cell transfusions in a retrospective study.

Background: Existing research presents conflicting results on the influence of blood donor sex on hemoglobin (Hb) change and transfusion-associated infection and mortality in transfusion recipients.

Aim: This retrospective study explored the association between donor and recipient sex on hospital-onset sepsis (HO-sepsis) and Hb changes in critically ill patients receiving red blood cell (RBC) transfusions.

Methods: Data from 2010-2020 were extracted from an academic hospital's clinical database and a blood supplier's donor database. HO-sepsis was determined based on the International Classification of Diseases and Related Health Problems 10th Revision (ICD-10) diagnostic codes without requiring a microbiology test within the first 48 h of admission. Hb increments were determined by comparing the last Hb result in the 24-h period prior to RBC unit issue and the first Hb result within 4-24 h after RBC unit issued for transfusion.

Results: 25,585 critically ill patients received one or more RBC transfusions; 3,410 were included in the HO-sepsis and 3,487 in the Hb increment analysis. There was no significant differences in the HO-sepsis rate among the four groups, but female recipients were more prone to HO-sepsis than males (OR 1.48,  = 0.04). Multivariate analysis found that the number of RBC unit transfused ( = 0.001) and recipient age ( = 0.03), but not recipient sex ( = 0.63), were significant contributors to HO-sepsis. Male blood was associated with higher Hb than female blood in female recipients ( = 0.007), but not in male recipients ( = 0.75). Variables such as donor Hb levels and recipient Hb level influenced Hb increments.

Conclusion: Blood donor sex was not associated with HO-sepsis in critically ill patients receiving RBC transfusion. Male to female transfusions were associated with a higher Hb increment in recipients. Further exploration of the impact of sex mis-matched transfusion on recipient outcomes is warranted.