Investigation of suspected TRALI cases in 2006–2011

Abstract

Introduction: Three decades ago, transfusionrelated acute lung injury (TRALI) became an independent clinical entity. In the following years it was recognized among the most common transfusion-related major morbidity and mortality causes. Consequently, preventive measures were introduced that reduced severe immune (antibody-mediated) TRALI cases. Since the first publications, immune (antibody-mediated) TRALI was associated with leukocyte antibodies of predominantly donor origin, which cause activation of recipient neutrophils in the lung and consequently an acute lung injury. In predisposed, severely ill patients soluble neutrophilpriming substances that accumulate in stored cellular blood components can trigger non-immune (antibody-independent) TRALI. Methods: In 2006–2011, eight suspected TRALI cases that met consensus clinical criteria and had chest radiograph were investigated in the Blood Transfusion Center of Slovenia. Patients and all donors of blood components transfused within 6 hours before the onset of acute respiratory distress were investigated for leukocyte antibodies against HLA class I and II antigens, and antibodies against neutrophil antigens HNA. All cases were investigated for patient, donor and blood component characteristics. In cooperation with clinicians, chest radiographs and alternative risk factors for acute lung injury (ALI) were evaluated.