Transfusion-Related Acute Lung Injury Associated with Interdonor Incompatibility for the Neutrophil-Specific Antigen HNA-1a

Abstract

Background and Objectives: A patient transfused with two pooled platelet concentrates became breathless. Bilateral infiltrates were seen on chest X-ray. A diagnosis of transfusion-related acute lung injury (TRALI) was made. The patient received 100% oxygen and recovered after 5 days. Materials and Methods: Antibody screening, cross-matching for granulocyte and lymphocyte antibodies and typing for granulocyte antigens was undertaken. Results: The patient typed as HNA-1b/HNA-1b. Granulocyte and lymphocyte antibodies were not detected in the patient’s serum or in any of the donor sera by cross-match. In antibody screening against typed panel granulocytes, complement-fixing anti-HNA-1a IgM antibodies were detected in the serum of one female donor. Two of the other donors who contributed to the pooled platelet concentrate containing the HNA-1a IgM antibodies typed as HNA-1a/HNA-1b. Conclusion: Anti-HNA-1a IgM antibodies may have formed immune complexes with white cell fragments or soluble FcγRIII from HNA-1a+ donors in the pooled platelet concentrate and initiated TRALI.

Transfusion‐related acute lung injury (TRALI): a serious adverse event of blood transfusion

“…Hypoxaemia, fever, hypotension, tachycardia and cyanosis also often occur. Although the symptoms usually commence within 1–2 h of transfusion, some patients can develop dyspnoea as late as 48 h after transfusion (atypical TRALI) [10–12]. Radiological examination shows bilateral pulmonary infiltrates consistent with pulmonary oedema.…”

“…Description of the HNA antigens is beyond the scope of this review and has recently been published in detail [28,29]. Of the antibodies with known specificity, those directed against the HNA‐1a (NA1), HNA‐1b (NA2), HNA‐2a (NB1), HNA‐3a (5b) and HLA‐A2 antigens have been reported most frequently [11,23,27,30–32]. More recently, antibodies to HLA class II antigens have been reported to be associated with TRALI [33].…”

“…An interdonor TRALI reaction (e.g. reaction of transfused antibodies with transfused leucocytes present in a blood component from a different donor) has also been described [11].…”

The effect of C1‐inhibitor in a murine model of transfusion‐related acute lung injury

“…Animal studies indicate that complement activation is required for development of TRALI . Also, in clinical TRALI cases, complement activation contributes to the inflammatory cascade . Antibodies in transfused components may result in activation of the complement system .…”

“…Also, in clinical TRALI cases, complement activation contributes to the inflammatory cascade . Antibodies in transfused components may result in activation of the complement system . Possibly, the formation of immune complexes activates the complement system via the classical pathway; however, the exact route of complement activation in TRALI remains to be established.…”