Background: Transfusion-related acute lung injury (TRALI) is a leading cause of transfusion-associated mortality for which multiple mitigation strategies have been implemented over the past decade. However, product-specific TRALI rates have not been reported longitudinally and may help refine additional mitigation strategies.
Study design and methods: This retrospective multicenter study included analysis of TRALI rates from 2007 through 2017. Numerators included definite or probable TRALI reports from five blood centers serving nine states in the United States. Denominators were components distributed from participating centers. Rates were calculated as per 100,000 components distributed (p < 0.05 significant).
Results: One hundred four TRALI cases were reported from 10,012,707 components distributed (TRALI rate of 1.04 per 100,000 components). The TRALI rate was 2.25 for female versus 1.08 for male donated components (p < .001). The TRALI rate declined from 2.88 in 2007 to 0.60 in 2017. From 2007 to 2013, there was a significantly higher TRALI rate associated with female versus male plasma (33.85 vs. 1.59; p < 0.001) and RBCs (1.97 vs. 1.15; p = 0.03). From 2014 through 2017, after implementation of mitigation strategies, a significantly higher TRALI rate only from female-donated plateletpheresis continued to be observed (2.98 vs. 0.75; p = 0.04).
Conclusion: Although the TRALI rates have substantially decreased secondary to multiple strategies over the past decade, a residual risk remains, particularly with female-donated plateletpheresis products. Additional tools that may further mitigate TRALI incidence include the use of buffy coat pooled platelets suspended in male donor plasma or platelet additive solution due to the lower amounts of residual plasma.
© 2019 AABB.
Predicted Effect of Selectively Testing Female Donors for HLA Antibodies to Mitigate Transfusion-Related Acute Lung Injury Risk From Apheresis PlateletsAF Eder et al. Transfusion 56 (6 Pt 2), 1608-15. PMID 26830063.TRALI was more likely after transfusion of apheresis PLTs than male-donor-predominant plasma or RBCs. A selective strategy to test all female plateletpheresis donors who …
Transfusion-related Acute Lung Injury Prevention Measures and Their Impact at Canadian Blood ServicesY Lin et al. Transfusion 52 (3), 567-74. PMID 21895676.Hemovigilance data demonstrated an initial increase in TRALI cases, likely due to increased adverse event reporting and awareness of TRALI, followed by a decrease in case …
Current Options for Transfusion-Related Acute Lung Injury Risk Mitigation in Platelet TransfusionsNM Dunbar. Curr Opin Hematol 22 (6), 554-8. PMID 26390161. - ReviewSubstantial progress has been made in reducing risk for antibody-mediated TRALI in plasma. The upcoming expansion of existing strategies for plasma mitigation to include …
How Much Residual Plasma May Cause TRALI?N Win et al. Transfus Med 18 (5), 276-80. PMID 18937733. - Case ReportsAlthough passive infusion of plasma-rich components containing white blood cell (WBC) antibodies are responsible for majority of the reported transfusion-related acute lu …
Analysis of Transfusion-Related Acute Lung Injury and Possible Transfusion-Related Acute Lung Injury Reported to the French Hemovigilance Network From 2007 to 2013G Andreu et al. Transfus Med Rev 32 (1), 16-27. PMID 28864336. - ReviewUsing the French Hemovigilance Network database from 2007 to 2013, we provide information on demographics, incidence, and risk factors of reported transfusion-related acu …