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Storage Duration and Cell Density as Predictors of Red Blood Cell-related Febrile Non-hemolytic Transfusion Reactions: A Matched Case-control Study
Sosnoski M, Sekine L and Faulhaber GAM
Background and objectives: Blood component storage lesion has been already associated with undesirable clinical endpoints. We have designed a case-control study evaluating the effect of storage time and supernatant content in the incidence of febrile non-hemolytic transfusion reaction (FNHTR).
Material and methods: Matched case-control study at a tertiary complexity hospital. cases were FNHTR experiencing patients from September 1st, 2015 to September 1st, 2016. Controls were selected from patients transfused in the same day, matched over gender, age, transfusion adverse events (TAE) and transfusion history and use of premedication. Only PRBC transfusions were enrolled. Parameters evaluated on PRBC were irradiation, leukoreduction, [Na+], [K+], hematocrit (Ht), hemoglobin (Hb), microbiological culture and storage time.
Results: We have found an annual FNHTR incidence of 0.38%. A total of 117 transfusions were accrued (FNHTR-39/ControlA-39/ControlB-39). Groups were balanced over matching variables. On univariable analysis, irradiation, leukoreduction and storage time did not associate with FNHTR. [Na+] decreased (Rho=-0.49, p<0.001) and [K+] increased (Rho=0.52, p<0.001) significantly over storage time, but concentrations did not differ between study groups. Microbiological culture was thoroughly negative for all groups. Ht (72.4[68.8-75.7] × 68.1[62.75-72]) and Hb (23.7[22.1-24.4] × 22.3[20.5-24]) were significantly higher in FNHTR group. Final multivariable regression model rendered two significantly associated variables: Hb and storage time. For each increase in 1 day of storage time, FNHTR chance increased a mean of 6.7% (95%CI:0.4%-13.4%); while for each elevation of 1 g/dL of hemoglobin, a mean increase of 49.1% (95%CI:17.5%-89.3%) in the chance of FNHTR was observed.
Conclusion: Cell density (estimated by hemoglobin and hematocrit concentration) and storage time seems to be associated to FNHTR incidence. Causal relation should be further evaluated.