Ten years of hemovigilance reports of transfusion-related acute lung injury in the United Kingdom and the impact of preferential use of male donor plasma

• Published in: Transfusion (Philadelphia, Pa.) Pa.), 2009-03, Vol.49 (3), p.440-452
• Main Authors: Chapman, Catherine E., Stainsby, Dorothy, Jones, Hilary, Love, Elizabeth, Massey, Edwin, Win, Nay, Navarrete, Cristina, Lucas, Geoff, Soni, Neil, Morgan, Cliff, Choo, Louise, Cohen, Hannah, Williamson, Lorna M.
• Format: Article
• Language: English
• Subjects: Acute Lung Injury - epidemiology; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Donors; Blood Transfusion - statistics & numerical data; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; England - epidemiology; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Plasma; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Respiratory system; Sex Factors; Time Factors; Transfusion Reaction; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Treatment Outcome
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/j.1537-2995.2008.01948.x

BACKGROUND AND METHODS: From 1996 through 2006, 195 cases were reported as transfusion‐related acute lung injury (TRALI) to the Serious Hazards of Transfusion scheme and from 1999 onward classified by probability, using clinical features and HLA and/or HNA typing. From late 2003, the National Blood Service provided 80 to 90 percent of fresh‐frozen plasma (FFP) and plasma for platelet (PLT) pools from male donors. RESULTS: Forty‐nine percent of reports were highly likely/probable TRALI, and 51 percent possible/unlikely. Of 96 investigations, donor antibodies recognizing recipient antigens were found in 73 cases (65%), with HLA Class I in 25 of those (40%), HLA Class II antibodies in 38 (62%), and granulocyte antibodies in 12 (17%). A review in 2003 revealed that the TRALI risk/component was 6.9 times higher for FFP and 8.2 times higher for PLTs than for red blood cells, and that in donors of implicated FFP/PLTs, white blood cell antibodies were found 3.6 times more often than by chance (p ≤ 0.0001), with all implicated donors being female. Provision of male plasma was associated with a reduction in TRALI reports from 36 in 2003 to 23 in each of 2004 and 2005 and 10 in 2006. Highly likely/probable cases reduced from 23 in 2003 to 10, 6, and 4 in the 3 subsequent years, with cases implicating FFP or PLTs falling from 16 to 9, 3, and 1 respectively. CONCLUSIONS: The risk of highly likely/probable TRALI due to FFP has fallen from 15.5 per million units issued during 1999 through 2004 to 3.2 per million during 2005 through 2006 (p = 0.0079) and from 14.0 per million to 5.8 per million for PLTs.