Measures to prevent TRALI

Engelfriet, C. P.; Reesink, H. W.; Wendel, Silvano; Biagini, S.; Trigo, Filipe; Fontão-Wendel, Rita; Taaning, Ellen; Jørgensen, Jan Stener; Riisom, K.; Krusius, Tom; Koskinen, Sinikka; Kretschmer, V.; Karger, Ralf; Lawlor, Emer; Okazaki, Hitoshi; Charlewood, Richard; Brand, Anneke; Solheim, Bjarte G.; Flesland, Øystein; Łętowska, Magdalena; Zupańska, B; Muñiz‐Díaz, Eduardo; Nogués, Núria; Senn, M.; Mansouri-Taleghani, Behrouz; Chapman, C.; Massey, Edwin; Navarrete, Cristina; Stainsby, D; Win, Nay; Williamson, Lorna M.; Kleinman, Steven; Kopko, Patricia; Silva, M.; Shulman, Ira A.; Holness, Leslie; Epstein, Jay S.

doi:10.1111/j.1423-0410.2006.00870.x

Cited by 42 publications

(13 citation statements)

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“…Many blood centres have developed local policies for investigating donors and managing implicated donors (Engelfriet et al , 2007). Although it may be more profitable to investigate donors of plasma‐rich components first, donors of plasma‐poor components should not be excluded from investigation.…”

Section: Discussionmentioning

confidence: 99%

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How much residual plasma may cause TRALI?

Win

Chapman

Bowles

et al. 2008

Transfusion Medicine

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Although passive infusion of plasma-rich components containing white blood cell (WBC) antibodies are responsible for majority of the reported transfusion-related acute lung injury (TRALI) cases, the minimum volume of residual plasma, which might trigger TRALI, is not known. We report three cases of TRALI where the implicated donor component contained between 10 and 20 mL of residual plasma. Two cases were related to transfusion of red blood cells prepared in optimal additive solution, and the other was related to transfusion of pooled buffy coat platelets. In the latter case, WBC antibodies that matched the patient's human leucocyte antigen (HLA) antigens were only found in one buffy coat donor (female) who contributed a buffy coat for pooled platelets preparation. Plasma prepared from pooling platelets was collected from a male donor. Laboratory investigation confirmed that in all three cases, the donors' serum contained three to four different HLA class 1-specific and class 11-specific antibodies that matched with the patient's HLA type. Our cases suggest that the residual plasma volume as small as 10-20 mL containing donor derived WBC antibodies may cause TRALI. The risk of TRALI remains, despite providing pooled platelets suspended in male donor plasma. The significance of multiple HLA antigen/antibody matching between donor and recipient in immune TRALI warrants further study.

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Section: Discussionmentioning

confidence: 99%

“…There has been international interest in reducing the risk of TRALI, and different countries have chosen a range of approaches (Engelfriet et al , 2007). These have centred on reduction of the use of high volume plasma components from female donors.…”

Section: Discussionmentioning

confidence: 99%

How much residual plasma may cause TRALI?

Win

Chapman

Bowles

et al. 2008

Transfusion Medicine

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“…Observations of TRALI cases should result in the procedures leading to decrease the risk of TRALI. Now, it is a good time to comment on this issue because of the recent International Forum on ‘Measures to Prevent TRALI’[41], which presents differing opinions (including one of the authors of this article). The measures, most often proposed are (1) permanent deferral of the donor implicated in a case of TRALI if antileucocyte antibody(ies) were detected, especially, if the cognate antigen in the patient was found (such donors may continue to serve as reagent donors or their blood may be used for research), (2) FFP prepared only from non‐transfused male donors or solvent/detergent (S/D) plasma – should be used, and (3) patients with leucocyte antibodies should receive leucodepleted RBCs and platelet concentrates.…”

Section: Discussionmentioning

confidence: 99%

Transfusion‐related acute lung injury and leucocyte‐reacting antibodies

et al. 2007

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Our clinical observations suggest that to distinguish between TRALI and possible TRALI is difficult and the results are equivocal - it is worth considering whether it can be omitted. We have confirmed that antibodies are involved in TRALI, although their role is very complex. The role of stored red blood cells in the development of TRALI requires further observations in comparison with a control group of patients without TRALI.

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“…Current risk reduction strategies (the preferential use of plasma from male donors, or the screening of donors for leucocyte antibodies) address the risk of TRALI associated with transfusion of leucocyte antibodies rather than BRM [17,26,27]. These BRM are thought to accumulate as part of the storage lesion of cellular blood products, such as packed red blood cell (PRBC) and platelet concentrates (PLT) [28-31].…”

Section: Introductionmentioning

confidence: 99%

Age of blood and recipient factors determine the severity of transfusion-related acute lung injury (TRALI)

et al. 2012

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IntroductionCritical care patients frequently receive blood transfusions. Some reports show an association between aged or stored blood and increased morbidity and mortality, including the development of transfusion-related acute lung injury (TRALI). However, the existence of conflicting data endorses the need for research to either reject this association, or to confirm it and elucidate the underlying mechanisms.MethodsTwenty-eight sheep were randomised into two groups, receiving saline or lipopolysaccharide (LPS). Sheep were further randomised to also receive transfusion of pooled and heat-inactivated supernatant from fresh (Day 1) or stored (Day 42) non-leucoreduced human packed red blood cells (PRBC) or an infusion of saline. TRALI was defined by hypoxaemia during or within two hours of transfusion and histological evidence of pulmonary oedema. Regression modelling compared physiology between groups, and to a previous study, using stored platelet concentrates (PLT). Samples of the transfused blood products also underwent cytokine array and biochemical analyses, and their neutrophil priming ability was measured in vitro.ResultsTRALI did not develop in sheep that first received saline-infusion. In contrast, 80% of sheep that first received LPS-infusion developed TRALI following transfusion with "stored PRBC." The decreased mean arterial pressure and cardiac output as well as increased central venous pressure and body temperature were more severe for TRALI induced by "stored PRBC" than by "stored PLT." Storage-related accumulation of several factors was demonstrated in both "stored PRBC" and "stored PLT", and was associated with increased in vitro neutrophil priming. Concentrations of several factors were higher in the "stored PRBC" than in the "stored PLT," however, there was no difference to neutrophil priming in vitro.ConclusionsIn this in vivo ovine model, both recipient and blood product factors contributed to the development of TRALI. Sick (LPS infused) sheep rather than healthy (saline infused) sheep predominantly developed TRALI when transfused with supernatant from stored but not fresh PRBC. "Stored PRBC" induced a more severe injury than "stored PLT" and had a different storage lesion profile, suggesting that these outcomes may be associated with storage lesion factors unique to each blood product type. Therefore, the transfusion of fresh rather than stored PRBC may minimise the risk of TRALI.

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Measures to prevent TRALI

Abstract: The donor is withdrawn from donation of therapeutic blood components, but may continue to donate as a reagent only donor for quality assurance if appropriate.

Cited by 42 publications

References 1 publication

How much residual plasma may cause TRALI?

How much residual plasma may cause TRALI?

Transfusion‐related acute lung injury and leucocyte‐reacting antibodies

Age of blood and recipient factors determine the severity of transfusion-related acute lung injury (TRALI)

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