Transfusions From Previously Pregnant Donors Add Risk To Younger Male Recipients Interview with:

Rutger Middelburg, PhD Assistant Professor in clinical epidemiology Sanquin Research and LUMC

Dr. Middelburg

Rutger Middelburg, PhD
Assistant Professor in clinical epidemiology
Sanquin Research and LUMC What is the background for this study?

Response: Six years ago we found transfusions from female donor to be associated with increased mortality among male recipients, especially under 50 years of age. This was an unexpected observation and we considered the probability of a false positive finding (i.e. a chance association) to be relatively high. We therefore immediately started a follow-up study with two main objectives. First, we wanted to confirm our findings in an independent and much larger cohort. Second, since some complications of blood transfusion are known to be related to pregnancy history of the donor, we wanted to study a possible relationship with previous pregnancy of the blood donors. What are the main findings?

Response: We found transfusion of red blood cells from previously pregnant donors to be associated with about 1.5 times increased mortality of male recipient under 50 years, compared to transfusion of red blood cells from male donors. The risk remained increased for many years after transfusion. No such increase was observed for female recipients or for male recipient over 50 years. What should clinicians and patients take away from your report?

Response: We think blood from previously pregnant donors increased mortality risk in young male recipients, but we do not know the underlying mechanism. The relation to pregnancy and the very long time that the risk remains increased, seems to suggest some kind immunological mechanism, but more research is needed to confirm and further specify the role of the immune system in this phenomenon. What recommendations do you have for future research as a result of this study?

Response: Future studies should look into more detailed pregnancy histories of the donors. We did not have any data on number of pregnancies or time since last pregnancy, for example. This could provide important clues about the mechanism.

Furthermore, highly speculatively, we may also hypothesize that regulatory T-cells could be involved. Research into the potential induction of circulating regulatory T-cells during pregnancy, could therefore also be potentially relevant. Is there anything else you would like to add?

Response: Besides the subject matter specific indications of this research, there is also a more general implication. This research shows how post-marketing surveillance of our own products has identified a potential target for further optimisation and personalisation of clinical transfusion medicine. If confirmed, these results could lead to an important improvement of patient care. This should be considered an important example for the pharmaceutical industry, which should also invest more in similar research of their own products. Thank you for your contribution to the community.


Caram-Deelder C, Kreuger AL, Evers D, de Vooght KMK, van de Kerkhof D, Visser O, Péquériaux NCV, Hudig F, Zwaginga JJ, van der Bom JG, Middelburg RA. Association of Blood Transfusion From Female Donors With and Without a History of Pregnancy With Mortality Among Male and Female Transfusion Recipients. JAMA.2017;318(15):1471–1478. doi:10.1001/jama.2017.14825

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on October 17, 2017 by Marie Benz MD FAAD