Antibody-mediated transfusion-related acute lung injury; from discovery to prevention

Br J Haematol. 2015 Sep;170(5):597-614. doi: 10.1111/bjh.13459. Epub 2015 Apr 28.

Abstract

Transfusion-related acute lung injury (TRALI), a syndrome of respiratory distress caused by blood transfusion, is the leading cause of transfusion-related mortality. The majority of TRALI cases have been related to passive infusion of human leucocyte antigen (HLA) and human neutrophil antigen (HNA) antibodies in donor blood. In vitro, ex vivo and in vivo animal models have provided insight in TRALI pathogenesis. The various classes of antibodies implicated in TRALI appear to have different pathophysiological mechanisms for the induction of TRALI involving endothelial cells, neutrophils, monocytes and, as very recently has been discovered, lymphocytes. The HLA and HNA-antibodies are found mainly in blood from multiparous women as they have become sensitized during pregnancy. The incidence of TRALI has decreased rapidly following the introduction of a male-only strategy for plasma donation. This review focuses on pre-clinical and clinical studies investigating the pathophysiology of antibody-mediated TRALI.

Keywords: human leucocyte antigens; human neutrophil antigens; pathophysiology; transfusion; transfusion-related acute lung injury.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acute Lung Injury* / epidemiology
  • Acute Lung Injury* / etiology
  • Acute Lung Injury* / immunology
  • Blood Transfusion*
  • Female
  • HLA Antigens / immunology*
  • Humans
  • Incidence
  • Isoantibodies / immunology*
  • Male
  • Pregnancy

Substances

  • HLA Antigens
  • Isoantibodies