TRALI risk reduction: Donor and component management strategies

Abstract

Transfusion-related lung injury (TRALI) occurs in approximately 1 in 5,000 transfusions and may cause considerably more morbidity and mortality that is not recognized in clinical practice. Based on the current understanding of the etiology of TRALI, blood centers have implemented or are evaluating various donor and component management strategies in an effort to mitigate the risk of TRALI. Many cases of TRALI are likely caused by antibodies to leukocyte antigens (HLA or HNA) in blood components. Approximately 10 to 20% of female blood donors with a history of pregnancy and 1 to 5% of male blood donors harbor these antibodies. Alternatively, TRALI may be mediated by other bioactive lipids or substances that accumulate during storage and cause a reaction when transfused to susceptible patients. The complex interplay among various donor-, component-, and patient-related factors underlying TRALI guarantees that effective prevention will not be a single or simple intervention but rather will require a multifaceted approach. Perhaps, the most important risk reduction strategy is the effort to ensure appropriate use of blood products and eliminate unnecessary transfusions. Blood collection agencies, however, have more proximate control over donor selection and component management than transfusion practice. AABB has provided some guidance on deferring donors implicated in TRALI and minimizing the preparation of high plasma volume components from donors who have anti-leukocyte antibodies or are at increased risk of leukocyte alloimmunization. Blood centers have taken various approaches to mitigate the risk of TRALI, and the possible benefit and the inherent limitations of the current strategies will be reviewed.

Massive transfusion in the trauma patient: Continuing Professional Development

“…For example, plasma transfusion is associated with a 1:2000 risk of developing TRALI, which is a greater risk than that of RBC transfusion, which carries a 1:5000 risk. 7,9 Supporting the antileukocyte antibodies mechanism, donor sex 11 Measures to reduce TRALI, such as diverting female plasma for fractionation and suspending platelet concentrates in male plasma, are currently in use in Canada, the United Kingdom, and the United States.…”

“…Les dons d'environ 10 à 20 % de femmes ayant un antécédent de grossesse contiennent des anticorps anti leucocytaires. 11 Les mesures pour réduire la survenue d'un TRALI, comme de fractionner de préférence le plasma donné par des femmes et d'ajouter du plasma de donneurs masculins aux concentrés plaquettaires ont actuellement cours en au Canada, au Royaume-Uni et aux É tats-Unis.…”

Pulmonary disorders, including vocal cord dysfunction

“…2,3 The donor plasma typically contains antibodies to human neutrophil antigens or HLA class I or II antigens. 2,3 Neutrophil alloantibodies are found in 10% to 20% of female donors and 1% to 4% of male donors, yet the incidence of TRALI is about 1:5000 transfusions. 3 Alloantibodies are generated during pregnancy, but of course that would not explain the presence of such antibodies in men.…”

“…2,3 Neutrophil alloantibodies are found in 10% to 20% of female donors and 1% to 4% of male donors, yet the incidence of TRALI is about 1:5000 transfusions. 3 Alloantibodies are generated during pregnancy, but of course that would not explain the presence of such antibodies in men. Some recipients have antineutrophil antibodies.…”

The merits of cell salvage in arthroplasty surgery: an overview

“…4 Unnecessary exposure to allogenic blood may result in the development of autoantibodies, increasing the risk of transfusionassociated acute lung injury, and making future crossmatching of blood increasingly difficult. 5 Furthermore, patients may have religious concerns about receiving allogenic or banked blood but may be open to autogenous blood that is reinfused immediately.…”