Investigating transfusion-related acute lung injury (TRALI)

Aim: Transfusion-related acute lung injury (TRALI) can be a life-threatening transfusion complication and should be considered whenever respiratory distress occurs during a transfusion. Management of donors implicated in TRALI is an important haemovigilance responsibility for blood services. To enable this, it is imperative to develop an effective strategy for investi-gating TRALI. The present paper describes an effective approach. Methods: Cases of suspected TRALI were referred to the Platelet and Granulocyte Immunobiology Laboratory at the Australian Red Cross Blood Service - Queensland; a reference neutrophil testing service. Recipient and donor samples were tested for the presence of leucocyte antibodies. Where possible, compatibility testing was performed between donor and recipient samples. Results: From March 1999 to June 2001, leucocyte antibodies directed against neutrophil-specific or human leucocyte antigens (HLA) were detected in at least one donor in seven of the nine cases investigated. Incompatibility with patient antigens (HNA-2a, non-specific HLA and HLA B5, B16, B35) was confirmed by cross matching in three cases. Conclusion: TRALI is a serious, non-infectious hazard of transfusion that must be reported and investigated promptly. Prompt investigations allow appropriate management of implicated donations and donors so as to minimize the incidence of TRALI. Therefore, the role of clinicians in reporting such cases and the hospital blood banks in collecting appropriate samples is critical. We suggest that hospital blood banks retain transfused donation units for at least 24 h after transfusion to exped-ite TRALI investigations. Due to the specialized nature of investigation, it is necessary to direct such investigations to specialist reference neutrophil testing services. In cases where the recipient has the leucocyte antibody, the use of white cell filters in future trans-fusions should be beneficial, because there is little evidence to substantiate the use of phenotyped blood products.