Abstract
Transfusion related acute lung injury (TRALI) is a rare but potentially fatal pulmonary
complication of transfusion that presents as acute hypoxemia and non-cardiogenic pulmonary
oedema, developing during or within six hours of transfusion. Majority of the cases
reported are due to transfusion of plasma rich blood components containing antibodies
to human leukocyte antigen (anti-HLA) or human neutrophil antigen (anti-HNA). Rarely,
anti-HLA or anti-HNA in recipients against transfused donor leukocyte antigens, cause
TRALI by a reverse mechanism. Herein, we report three cases of suspected TRALI following
transfusions of buffy coat derived granulocytes and peripheral blood stem cells. Three
patients with hematological malignancies developed pulmonary symptoms after transfusions
of leukocyte rich blood components. All cases showed findings of bilateral pulmonary
infiltrates at chest radiography and patients were managed accordingly; however, all
three expired within seven days of transfusion due to progressive respiratory deterioration.
The patients were transfusion dependent for a long time and had received multiple
non-leukoreduced blood components in the past. Clinical findings in all three cases
indicate the possibility of reverse TRALI. Although, patients’ anti-HLA or anti-HNA
antibodies concordance with donors’ cognate antigens (HLA and HNA) was not confirmed;
yet these three cases suggest that reverse pathogenesis of TRALI is not as infrequent
as reported in the literature. However, reverse TRALI has not been confirmed as the
presence and nature of antibodies in the transfused recipient were not investigated
due to the non availability of immunodiagnostic tests in India.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Transfusion and Apheresis ScienceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Toward an understanding of transfusion-related acute lung injury: statement of a consensus panel.Transfusion. 2004; 44: 1774-1789
- A consensus redefinition of transfusion-related acute lung injury.Transfusion. 2019; 59: 2465-2476
- Targeting transfusion-related acute lung injury: the journey from basic science to novel therapies.Crit Care Med. 2018; 46: e452-e458
- Transfusion-associated circulatory overload and transfusion-related acute lung injury.Blood. 2019; 133: 1840-1853
- Transfusion-related acute lung injury: a clinical review.Lancet. 2013; 382: 984-994
- Transfusion-related acute lung injury (TRALI)—under-diagnosed and under-reported.Br J Anaesth. 2003; 90: 573-576
- The pathogenic involvement of neutrophils in acute respiratory distress syndrome and transfusion-related acute lung injury.Transfus Med Hemother. 2018; 45: 290-298
- Transfusion-related acute lung injury: past, present, and future.Am J Clin Pathol. 2008; 129: 287-297
- Revised international surveillance case definition of transfusion-associated circulatory overload: a classification agreement validation study.Lancet Haematol. 2019; 6: e350-e358
- Granulocyte transfusion therapy and amphotericin B: adverse reactions?.Am J Hematol. 1989; 31: 102-108
- Use of granulocyte transfusions in two national cohorts and association between transfusion dose and patient outcomes: the best collaborative study.Blood. 2021; 138: 3242https://doi.org/10.1182/blood-2021-147531
- Transfusion-associated acute lung injury following donor granulocyte transfusion in two pediatric patients.J Pedia Intensive Care. 2019; 8: 251-254
- Are we underestimating reverse TRALI?.Transfusion. 2019; 59: 2788-2793
- A possible case of recipient anti-neutrophil and anti-human leukocyte antigen antibody-mediated fatal reverse transfusion-related acute lung injury.Transfusion. 2021; 61: 1336-1340
- Transfusion of target antigens to preimmunized recipients: a new mechanism in transfusion-related acute lung injury.Blood Adv. 2021; 5: 3975-3985
Article info
Publication history
Published online: May 25, 2022
Accepted:
May 17,
2022
Received in revised form:
April 26,
2022
Received:
March 1,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
