A randomized controlled trial oftransfusion‐related acute lung injury: is plasma from multiparous blood donors dangerous?

Palfi, Miodrag; Berg, Sören; Ernerudh, Jan; Berlin, Gösta

doi:10.1046/j.1537-2995.2001.41030317.x

Cited by 199 publications

(133 citation statements)

References 39 publications

(49 reference statements)

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“…Other supportive clinical data include a prospective randomized crossover study of two units of plasma from multiparous donors (≥ 3 live births) versus control plasma in 105 intensive care patients. 26 This study found that patients who received study plasma had impaired lung function as evidenced by a decrease in PaO 2 :FiO 2 ratio versus controls. Dykes et al 27 reported TRALI in a single lung transplant recipient after a red cell transfusion containing HLA-B44 antibodies.…”

Section: Immune (Antibody)-mediated Tralimentioning

confidence: 74%

Transfusion-Related Acute Lung Injury: An Update

Triulzi

2006

Hematology

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Transfusion-associated acute lung injury (TRALI) has emerged as a leading cause of transfusion-related morbidity and mortality. TRALI is characterized by acute non-cardiogenic pulmonary edema and respiratory compromise in the setting of transfusion. The study of TRALI has been hampered by inadequate case definitions and an incomplete understanding of the pathologic mechanisms. Recent consensus conferences took an important first step by providing a framework for case definition. Recent advances in the understanding of the pathogenesis of TRALI have also occurred. TRALI has been primarily attributed to donor leukocyte antibodies that are thought to interact with recipient neutrophils, resulting in activation and aggregation in pulmonary capillaries, release of local biologic response modifiers causing capillary leak, and lung injury. An alternate mechanism termed the "two hit" or "neutrophil priming" hypothesis postulates that a pathway to neutrophil activation and aggregation can occur without leukocyte antibodies. A first event such as sepsis or trauma can induce pulmonary endothelial activation, release of cytokines, and priming of neutrophils. A subsequent second event such as exposure to lipids, cytokines or antibodies in a blood component would then cause activation of adherent neutrophils and a release of bioreactive molecules leading to lung injury. There are limited clinical and animal studies to support the "two hit" model. These proposed mechanisms are not mutually exclusive in that donor leukocyte antibody can be pathogenic in both models and have implications for new strategies to prevent TRALI.Advances in blood safety have greatly reduced the risk of transfusion-associated infectious disease transmission. As a result, noninfectious serious hazards of transfusion have come to the forefront as increasingly important blood safety issues. Transfusion-associated acute lung injury (TRALI) has emerged as a leading cause of transfusion related morbidity and mortality.1 This report will summarize recent consensus conferences that have provided practical clinical definitions of TRALI to aid the clinician in diagnosis and to facilitate its study. Recent advances in understanding of the pathogenesis of TRALI will be presented with a potential unifying hypothesis. DefinitionA lack of a standardized definition of TRALI has hindered accurate clinical diagnosis, epidemiology, and research investigation. A recent NHLBI working group convened to identify research needs addressed this critical issue by providing the following definition: "new acute lung injury (ALI) occurring during or within 6 hours after a transfusion, with a clear temporal relationship to transfusion, in patients without or with risk factors for ALI other than transfusion."2 Limitations to the proposed NHLBI working group definition are the exclusion of patients with preexisting ALI, excluding cases with onset more than 6 hours after transfusion, lack of laboratory diagnostic criteria, and a required severity of hypoxia that would miss cases of mil...

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Section: Immune (Antibody)-mediated Tralimentioning

confidence: 74%

Transfusion-Related Acute Lung Injury: An Update

Triulzi

2006

Hematology

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“…The clinical significance of plasma from multiparous donors was confirmed by Palfi et al (2001). They showed that, in a prospective randomised controlled trial of 100 intensive care patients receiving a unit of control plasma and, 4-h later, a plasma unit from a multiparous donor or vice versa, transfusion of plasma from multiparous donors was associated with significantly lower oxygen saturation and higher TNF-a concentrations than transfusion of control plasma.…”

Section: Prevention Of Tralimentioning

confidence: 94%

The pathogenesis of transfusion‐related acute lung injury (TRALI)

2007

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SummaryIn recent years, transfusion-related acute lung injury (TRALI) has developed from an almost unknown transfusion reaction to the most common cause of transfusion-related major morbidities and fatalities. A clinical definition of TRALI was established in 2004, based on acute respiratory distress, noncardiogenic lung oedema temporal association with transfusion and hypoxaemia. Histological findings reveal lung oedema, capillary leucostasis and neutrophil extravasation. However, the pathogenesis of TRALI remains controversial. Leucocyte antibodies, present in fresh frozen plasma and platelet concentrates from multiparous donors, and neutrophil priming agents released in stored cellular blood components have been considered to be causative. As neutrophils and endothelial cells are pivotal in the pathogenesis of TRALI, a threshold model was established to try to unify the various reported findings on pathogenesis. This model comprises the priming of neutrophils and/or endothelium by the patient's co-morbidity, neutrophil and/or endothelial cell activation by the transfused blood component, and the severity of the TRALI reaction.

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“…This antibody-antigen interaction then initiates a cascade of cellular activity in the lung, resulting in endothelial damage and capillary leakage into alveoli [45]. Women who have had multiple pregnancies and patients with a history of prior transfusions are the most likely donors to be implicated in cases of TRALI [46]. Of particular interest in the obstetric setting is the association of TRALI in children whose mothers act as directed blood donors.…”

Section: Transfusion-associated Acute Lung Injurymentioning

confidence: 99%