Comparing transfusion reaction rates for various plasma types: a systematic review and meta-analysis/regression

Abstract

Background: We estimated rates for common plasma-associated transfusion reactions and compared reported rates for various plasma types.

Study design and methods: We performed a systematic review and meta-analysis of peer-reviewed articles that reported plasma transfusion reaction rates. Random-effects pooled rates were calculated and compared between plasma types. Meta-regression was used to compare various plasma types with regard to their reported plasma transfusion reaction rates.

Results: Forty-eight studies reported transfusion reaction rates for fresh-frozen plasma (FFP; mixed-sex and male-only), amotosalen INTERCEPT FFP, methylene blue-treated FFP, and solvent/detergent-treated pooled plasma. Random-effects pooled average rates for FFP were: allergic reactions, 92/10⁵ units transfused (95% confidence interval [CI], 46-184/10⁵ units transfused); febrile nonhemolytic transfusion reactions (FNHTRs), 12/10⁵ units transfused (95% CI, 7-22/10⁵ units transfused); transfusion-associated circulatory overload (TACO), 6/10⁵ units transfused (95% CI, 1-30/10⁵ units transfused); transfusion-related acute lung injury (TRALI), 1.8/10⁵ units transfused (95% CI, 1.2-2.7/10⁵ units transfused); and anaphylactic reactions, 0.8/10⁵ units transfused (95% CI, 0-45.7/10⁵ units transfused). Risk differences between plasma types were not significant for allergic reactions, TACO, or anaphylactic reactions. Methylene blue-treated FFP led to fewer FNHTRs than FFP (risk difference = -15.3 FNHTRs/10⁵ units transfused; 95% CI, -24.7 to -7.1 reactions/10⁵ units transfused); and male-only FFP led to fewer cases of TRALI than mixed-sex FFP (risk difference = -0.74 TRALI/10⁵ units transfused; 95% CI, -2.42 to -0.42 injuries/10⁵ units transfused).

Conclusion: Meta-regression demonstrates that the rate of FNHTRs is lower for methylene blue-treated compared with FFP, and the rate of TRALI is lower for male-only than for mixed-sex FFP; whereas no significant differences are observed between plasma types for allergic reactions, TACO, or anaphylactic reactions. Reported transfusion reaction rates suffer from high heterogeneity.