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

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.