Abstract
We reviewed 13 cases of serologically confirmed Transfusion-Related Acute Lung Injury (TRALI) reported to our blood center over a five-year period. Cognate antigen-antibody pairs were noted, as well as product transfused, indication for transfusion, onset of symptoms related to transfusion and time to resolution. All patients demonstrated bilateral pulmonary edema on CXR. Onset of symptoms for all cases occurred during transfusion of implicated product, or within one hour post-transfusion. All donors of implicated products were multiparous females. The majority of implicated products (77%) were FFP. There were 3 TRALI deaths, all resulted from transfusion of FFP. Anti-neutrophil, HLA Class I and/or Class II antibodies were identified in all fatal cases. Platelets comprised 15% of implicated products, and RBC’s only a single case (7 %). Among patients with TRALI receiving FFP, the most common indication was reversal of anticoagulation (50%). Chart review in two cases indicated Vitamin K in lieu of FFP may have been appropriate.
Patient . | Product . | Reason for Tx . | Time to Resolution . | Neutrophil Antibody . | HLA I . | HLA II . | HLA PRA . |
---|---|---|---|---|---|---|---|
1 | FFP | Reverse anticoag. | Death @ 7 hours | HNA-3a | Neg. | Neg. | 0 |
2 | Platelet | Thrombocytopenia | <1 day | + | Neg. | Neg. | 0 |
3 | FFP | Reverse anticoag. | 2 days | + | Neg. | Neg. | 0 |
4 | Platelet | Pancytopenia | <1 day | + | Neg. | Neg. | 0 |
5 | FFP | Reverse anticoag. | 4 days | + | A2 B3 | DR 52 | I - 90% II - 56% |
6 | FFP | Not available | unknown | + | Neg. | Neg. | 0 |
7 | FFP | Periop. Bleeding | unknown | Not tested | A2 | Neg. | 40% |
8 | FFP | Reverse anticoag. | 2 weeks | Not tested | Neg. | DR 17 | 63% |
9 | Cryopoor plasma | TTP | 4 days | Not tested | Neg. | DR 52 | 41% |
10 | FFP | Reverse anticoag. | Death @ 4 hours | Not tested | B 50 | DR 16 | I - 95% II - 89% |
11 | RBC | Bleeding | 2 days | Not tested | Neg. | DR 52 | 60% |
12 | FFP | GI Bleed | Death | Not tested | Neg. | DR 53 DQ 5 | 60% |
13 | FFP | GI Bleed | 2 days | Not tested | Neg | DR 52 | 60% |
Patient . | Product . | Reason for Tx . | Time to Resolution . | Neutrophil Antibody . | HLA I . | HLA II . | HLA PRA . |
---|---|---|---|---|---|---|---|
1 | FFP | Reverse anticoag. | Death @ 7 hours | HNA-3a | Neg. | Neg. | 0 |
2 | Platelet | Thrombocytopenia | <1 day | + | Neg. | Neg. | 0 |
3 | FFP | Reverse anticoag. | 2 days | + | Neg. | Neg. | 0 |
4 | Platelet | Pancytopenia | <1 day | + | Neg. | Neg. | 0 |
5 | FFP | Reverse anticoag. | 4 days | + | A2 B3 | DR 52 | I - 90% II - 56% |
6 | FFP | Not available | unknown | + | Neg. | Neg. | 0 |
7 | FFP | Periop. Bleeding | unknown | Not tested | A2 | Neg. | 40% |
8 | FFP | Reverse anticoag. | 2 weeks | Not tested | Neg. | DR 17 | 63% |
9 | Cryopoor plasma | TTP | 4 days | Not tested | Neg. | DR 52 | 41% |
10 | FFP | Reverse anticoag. | Death @ 4 hours | Not tested | B 50 | DR 16 | I - 95% II - 89% |
11 | RBC | Bleeding | 2 days | Not tested | Neg. | DR 52 | 60% |
12 | FFP | GI Bleed | Death | Not tested | Neg. | DR 53 DQ 5 | 60% |
13 | FFP | GI Bleed | 2 days | Not tested | Neg | DR 52 | 60% |
In our small series, the majority of implicated products were FFP, and all products were from multiparous females. Production of FFP exclusively from male donors is currently under consideration. Although male donor plasma can be expected to reduce the risk of TRALI associated with transfusion of FFP, it will not eliminate it entirely. Therefore, the risk of TRALI should be factored into the decision to transfuse all products. FFP should be administered cautiously for all indications, including reversal of anticoagulation.
Disclosure: No relevant conflicts of interest to declare.
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