Transfusion-related acute lung injury (TRALI) in two thalassaemia patients caused by the same multiparous blood donor

Abstract

We report two separate episodes of transfusion-related acute lung injury (TRALI) in two thalassaemia patients who received red blood cell transfusions from the same multiparous donor. Both cases had the same symptomatology and occurred within 60 minutes of transfusion. The patients presented dyspnoea, sweating, fatigue, dizziness, fever, and sense of losing consciousness. The chest x-ray showed a pulmonary oedema-like picture with both lungs filled with fluid. The patients were treated in the intensive therapy unit. They were weaned off the ventilator and discharged following hospitalization 7 and 9 days respectively. The TRALI syndrome was diagnosed to be associated with HLA-specific donor antibodies against mismatched HLA-antigens of the transfused patients. Haemovigilance improvements are essential for reducing the morbidity and mortality in transfused patients. Blood from multiparous donors should be tested for the presence of IgG HLA-Class I and –Class II antibodies before being transfused in thalassaemia and other chronically transfused patients.

Increased mortality in male recipients of red cells from ever pregnant female donors : mHAGs on red cells to blame ?

“…It was already shown that plasma from pregnant female patients could cause transfusion-associated lung injury (TRALI) 1 so, increasingly plasma obtained from female donors with a history of pregnancy is no-longer used for routine plasma transfusion. In addition, TRALI associated with red blood cell transfusion by a multiparous woman, as reported in a later paper of this Journal 2 , has also been described. Recent evidence as obtained from one extensive study showed that red cell concentrates cause a significant increase in mortality in the male patients who received red cells from ever pregnant female donors.…”

Transfusion‐Related acute lung injury (TRALI) caused by antibodies to HLA‐DRB1* 07:01 and HLA‐DQB1*02:02: A case report

“…Hence, most studies indicate that HLA-II antibodies in the plasma of parous women are a major cause of TRALI. 20,23,24 After the inclusion of plasma from male donors in several countries, such as the USA, the UK, Germany, and Australia, to mitigate the risk of TRALI, the incidence of TRALI decreased significantly. [25][26][27][28][29][30] The blood donor, in the present case, was identified as female.…”

“…The triggering blood component in 14 of 25 TRALI cases was shown to be FFP. Hence, most studies indicate that HLA‐II antibodies in the plasma of parous women are a major cause of TRALI 20,23,24 . After the inclusion of plasma from male donors in several countries, such as the USA, the UK, Germany, and Australia, to mitigate the risk of TRALI, the incidence of TRALI decreased significantly 25–30 …”

The History of Deferiprone (L1) and the Complete Treatment of Iron Overload in Thalassaemia

“…118,119 Changes in the therapeutic strategies are necessary under special circumstances such as pregnancy, splenomegaly, and infections and also when considering the possible introduction of erythropoietic biological or other emerging therapies. [120][121][122][123] Similar considerations are in progress regarding other clinical issues such as the early initiation of chelation therapy using L1 in thalassaemia children from about one year of age and also the initiation of combination therapies. [124][125][126][127] There are different criteria and opinions regarding the latter, with the ICOC L1/DF combination, for example, to be available, safe and flexible in all the patient categories and cases depending on the iron load levels and the rate of body iron intake from transfusions, whereas for other groups of investigators different restrictions are imposed in the use of combination protocols (Figure 6).…”