Abstract: Objective Systematically explain the differential effects of various biological characteristics of blood donors on the incidence of febrile non-hemolytic transfusion reaction and allergic transfusion reaction in red blood cell transfusion, and clarify their independent related risk factors, so as to provide evidence-based basis for pre-risk screening and clinical accurate blood use in blood collection and supply institutions. Methods A total of 337 756 bags of red blood cell infusion records from January 2020 to December 2025 in six hemovigilance sentinel hospitals in China were included, and the information of gender, age, blood donation times and ABO blood group of the corresponding blood donors were collected. Different types of red blood cell preparations and monitoring sentinel sites were simultaneously included as confounding variables, and univariate analysis was completed by chi-square test. Independent influencing factors of two kinds of adverse reactions were screened by binary unconditional Logistic regression model. The adverse blood transfusion reactions reported by 6 hospitals participating in HV in China from January 2020 to December 2025 and all clinical red blood components were collected, and the influence of gender, age, blood donation times and ABO blood type of related blood donors on the occurrence of adverse blood transfusion reactions was analyzed. The differences of ATR and FNHTR occurred in the infusion of different red blood cell blood components. Results The total incidence of FNHTR was 0.099%, the highest was suspended red blood cells (0.420%) and the lowest was washed red blood cells (0.036%). The total incidence of ATR was 0.086%, the highest was irradiated suspended red blood cells (0.230%) and the lowest was leucocyte-depleted suspended red blood cells (0.065%). Univariate analysis showed that there were statistical differences in the incidence of FNHTR and ATR between blood types and different sentinel units, and the influence of blood donor characteristics on the incidence of FNHTR was statistically significant, but there was no statistical difference in ATR. Multivariate Logistic regression analysis showed that blood type and monitoring sentinel were independent influencing factors of FNHTR and ATR, the characteristics of blood donors were not independent influencing factors of FNHTR, and the gender of blood donors was independent influencing factor of ATR. The risk of ATR in male blood donors after red blood cell transfusion was significantly lower than that in women. Conclusion There are significant differences in the intensity and path of the biological characteristics of blood donors to the two kinds of adverse reactions, and the heterogeneity of blood product processing technology and clinical monitoring is the more critical influencing factor. In the future, an associated database of "blood donors, blood products and recipients" should be established to promote accurate blood transfusion.

Key words: Characteristics of blood donors, Adverse reactions of blood transfusion, Febrile non-hemolytic transfusion reaction, Allergic transfusion reaction