The residual risk of transfusion‐related acute lung injury at the American Red Cross (2008‐2011): limitations of a predominantly male‐donor plasma mitigation strategy

Abstract

The risk of TRALI after plasma transfusion has been markedly reduced for blood groups A, B, and O but not for AB, reflecting continued reliance on group AB plasma from female donors to meet increasing demand.

Optimal Fluid Therapy for Traumatic Hemorrhagic Shock

“…The rationale is that 1) 85% of individuals in the US have either type A or type O blood, 88 making type A plasma compatible with the vast majority of potential recipients, 2) the plasma transfused with type O apheresis platelets is routinely given to type-incompatible recipients with hemolytic reactions occurring very rarely, 89,90 3) laboratory examination of male type A plasma units found predominantly low titers of anti-B, 91 and 4) the risk of transfusion-related acute lung injury (TRALI) is currently much higher with type AB plasma than type A. 92 Based on limited retrospective data, the emergency use of type A plasma appears safe. 93,94,95 As this practice becomes widespread, 96 more accurate data about the safety profile of this practice will soon become available.…”

“…130 Although any blood product may precipitate TRALI, the risk was historically highest with plasma. 92 Recognizing that a significant source of TRALI cases were precipitated by plasma donated by multiparous women who likely developed alloantibodies after becoming sensitized during pregnancy, initiatives were introduced in 2006 to reduce the incidence of TRALI. 92 This included screening programs and preferentially using plasma from male donors for transfusion.…”

“…92 Recognizing that a significant source of TRALI cases were precipitated by plasma donated by multiparous women who likely developed alloantibodies after becoming sensitized during pregnancy, initiatives were introduced in 2006 to reduce the incidence of TRALI. 92 This included screening programs and preferentially using plasma from male donors for transfusion. After implementation of these initiatives, the American Red Cross reported that the incidence of TRALI decreased from 18.6 cases per million plasma units transfused to 4.2 cases per million, no different from the TRALI risk associated with PRBC.…”

“…After implementation of these initiatives, the American Red Cross reported that the incidence of TRALI decreased from 18.6 cases per million plasma units transfused to 4.2 cases per million, no different from the TRALI risk associated with PRBC. 92 An exception is type AB plasma; due to its scarcity, a substantial proportion of transfused AB plasma continues to come from female donors. As a result, the incidence of TRALI associated with AB plasma has remained constant.…”

Transfusion‐related acute lung injury–associated HNA‐3a antibodies recognize complex determinants on choline transporter‐like protein 2

“…New approaches to donor selection 7,8 have reduced the incidence of TRALI but are not feasible in all situations and are not totally effective. Consequently, TRALI remains an important cause of morbidity and mortality in transfusion recipients.…”