The two-event model of transfusion-related acute lung injury

Silliman, Christopher C.

doi:10.1097/01.ccm.0000214292.62276.8e

Cited by 204 publications

(215 citation statements)

References 100 publications

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“…43 Alternatively, the 'two-event' model proposes that factors present in transfused stored blood products trigger TRALI in patients in whom endothelial activation is already present due to an initial proinflammatory event, for example, infection, surgery, or trauma. 42 Transfusion-related immunomodulation proposes that deleterious proinflammatory effects result from a complex interplay between transfusion effects, genetic factors, intercurrent illnesses, and inflammatory mediators and effector cells. 44 However, a causal relationship between transfusion and these serious complications is not established.…”

Section: Transfusion and Preoperative Anaemiamentioning

confidence: 99%

Patient Blood Management in Europe

Shander¹,

Aken²,

Gombotz³

et al. 2013

Survey of Anesthesiology

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Section: Transfusion and Preoperative Anaemiamentioning

confidence: 99%

Patient Blood Management in Europe

Shander¹,

Aken²,

Gombotz³

et al. 2013

Survey of Anesthesiology

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“…Silliman and his colleagues have shown that this can be a mechanism of acute lung injury, and Gajic and his colleagues have shown that concentrations of lysophospholipids in stored red blood cell units are associated with increased rates of lung injury in intensive care patients [28,29]. However, rates of TRALI are markedly reduced when plasma from women donors is removed from the blood supply, so the role of lysophospholipids in causing clinically important lung injury is not clear [30].…”

Section: Are Stored Red Blood Cells Safe?mentioning

confidence: 99%

Current issues relating to the transfusion of stored red blood cells

Zimrin¹,

2009

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The development of blood storage systems allowed donation and transfusion to be separated in time and space. This separation has permitted the regionalization of donor services with subsequent economies of scale and improvements in the quality and availability of blood products. However, the availability of storage raises the question of how long blood products can and should be stored and how long they are safe and effective. The efficacy of red blood cells was originally measured as the increment in haematocrit and safety began with typing and the effort to reduce the risk of bacterial contamination. Appreciation of a growing list of storage lesions of red blood cells has developed with our increasing understanding of red blood cell physiology and our experience with red blood cell transfusion. However, other than frank haemolysis, rare episodes of bacterial contamination and overgrowth, the reduction of oxygen-carrying capacity associated with the failure of some transfused cells to circulate, and the toxicity of lysophospholipids released from membrane breakdown, storage-induced lesions have not had obvious correlations with safety or efficacy. The safety of red blood cell storage has also been approached in retrospective epidemiologic studies of transfused patients, but the results are frequently biased by the fact that sicker patients are transfused more often and blood banks do not issue blood products in a random order. Several large prospective studies of the safety of stored red blood cells are planned.

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“…1,2,4,5 TRALI has been reported to be the result of at least 2 events: the first pertaining to the clinical condition of the patient, and the second to the infusion of antibodies that recognize human lymphocyte antigen (HLA) class I, class II, or granulocyte antigens or the infusion of biological response modifiers, which include both biologically active lipids and soluble CD40 ligand (sCD40L). [6][7][8][9][10][11][12][13][14][15] Standard prestorage leukoreduction (LR) was reported to have decreased TRALI reactions at 1 medical center; however, LR has not affected TRALI incidence in the United States or worldwide. 16,17 To date, there are few RBC mitigation strategies for TRALI.…”

Section: Introductionmentioning

confidence: 99%

Experimental prestorage filtration removes antibodies and decreases lipids in RBC supernatants mitigating TRALI in vivo

Silliman

Kelher

Khan³

et al. 2014

Blood

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Key Points• TRALI may be induced by antibodies to HLA or HNA antigens or lipids, which accumulate during storage.• Prestorage experimental filtration of RBCs removes HLA and HNA antibodies, decreases lipid priming activity, and mitigates TRALI in an animal model.Transfusion-related acute lung injury (TRALI) remains a significant cause of transfusionrelated mortality with red cell transfusion. We hypothesize that prestorage filtration may reduce proinflammatory activity in the red blood cell (RBC) supernatant and prevent TRALI. Filters were manufactured for both small volumes and RBC units. Plasma containing antibodies to human lymphocyte antigen (HLA)-A2 or human neutrophil antigen (HNA)-3a was filtered, and immunoglobulins and specific HNA-3a and HLA-2a neutrophil (PMN) priming activity were measured. Antibodies to OX27 were added to plasma, and filtration was evaluated in a 2-event animal model of TRALI. RBC units from 31 donors known to have antibodies against HLA antigens and from 16 antibody-negative controls were filtered. Furthermore, 4 RBC units were drawn and underwent standard leukoreduction. Immunoglobulins, HLA antibodies, PMN priming activity, and the ability to induce TRALI in an animal model were measured. Small-volume filtration of plasma removed >96% of IgG, antibodies to HLA-A2 and HNA-3a, and their respective priming activity, as well as mitigating antibodymediated in vivo TRALI. In RBC units, experimental filtration removed antibodies to HLA antigens and inhibited the accumulation of lipid priming activity and lipid-mediated TRALI. We conclude that filtration removes proinflammatory activity and the ability to induce TRALI from RBCs and may represent a TRALI mitigation step. (Blood. 2014;123(22):3488-3495)

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The two-event model of transfusion-related acute lung injury

Cited by 204 publications

References 100 publications

Patient Blood Management in Europe

Patient Blood Management in Europe

Current issues relating to the transfusion of stored red blood cells

Experimental prestorage filtration removes antibodies and decreases lipids in RBC supernatants mitigating TRALI in vivo

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