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.

Comparison of Serologically Confirmed TRALI Cases

PatientProductReason for TxTime to ResolutionNeutrophil AntibodyHLA IHLA IIHLA 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% 
PatientProductReason for TxTime to ResolutionNeutrophil AntibodyHLA IHLA IIHLA 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% 
View Large

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.

Topics:
transfusion-related acute lung injury, fresh-frozen plasma, transfusion, anticoagulants, human leukocyte antigens, antibodies, anticoagulation reversal, gastrointestinal bleeding, hemorrhage, symptom onset

Disclosure: No relevant conflicts of interest to declare.

Author notes

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Corresponding author

2006, The American Society of Hematology
2006
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