Today we will be discussing TRALI, or transfusion-related acute lung injury. TRALI accounts for almost half of all transfusion-related fatalities in the United States.
Although several mechanisms exist, one of the major causes of TRALI is donor antibodies to white blood cells, such as human leukocyte antigen and human neutrophil antigen, or commonly referred to as HLA and HNA.
Dr. AuBuchon who wrote an editorial in TRANSFUSION comments:
“Blood collectors in the United States have taken steps over the last half-dozen years to reduce the risk of TRALI through plasma, and, in many cases, also apheresis platelets. This has primarily involved women who have previously been pregnant, either deferring the use of their plasma or testing them to identify those lacking HLA antibodies. These steps have resulted in a reduction of TRALI risk by about three-quarters.”
Dr. Vandekerckhove and his colleagues in Belgium screened 77 male plateletpheresis donors with a history of transfusions and 942 female donors. Overall, 20.2% of the donors had HLA antibodies.
Here is Dr. Vandekerckhove with the major findings of the study:
“Our study indicates that a history of transfusion is a minor risk factor for immunization against HLA antigens, but in contrast, former pregnancies constitute a major risk factor for the development of HLA antibodies.”
Further research is needed to fully understand novel treatments to attenuate TRALI.
Again, here is Dr. AuBuchon:
“We also have yet to devise a simple, effective and uniform approach to donor management in TRALI cases. Development of such a system is hampered by the recognition that TRALI is a bedside—not a laboratory—diagnosis, and some units that cause what we call TRALI do not have any HLA or HNA antibodies.”
A recently published paper in BLOOD, examined the therapeutic effects of aspirin and aspirin-triggered lipoxin in mice with TRALI. Whether the same treatments can be used successfully in human patients awaits further research.
We’ll be back with another edition of Transfusion News after the holidays on January 15th. Thanks for joining us.
References
1. AuBuchon J. TRALI: reducing its risk while trying to understand its causes. Transfusion 2014;54:3021-3025.
2. De Clippel D, Baeten M, Torfs A, Emonds MP, Feys HB, Compernolle V, Vandekerckhove P. Screening for HLA antibodies in plateletpheresis donors with a history of transfusion or pregnancy. Transfusion 2014. doi: 10.1111/trf.12727
3. Ortiz-Munoz G, Mallavia B, Bins A, Headley M, Krummel MF, Looney MR. Aspirin-triggered 15-epi-lipoxin A4 regulates neutrophil-platelet aggregation and attenuates acute lung injury in mice. Blood 2014;124: 2625-34.
4. Zimring JC. The fat and the skinny on acute lung injury. Blood 2014;124: 2617-8.
