Study on transfusion-related acute lung injury caused by HLA-Ⅱ antibody / 中国输血杂志

【Objective】 To explore the risk factors of transfusion-related acute lung injury (TRALI). 【Methods】 The clinical symptoms, signs, imaging examinations, and laboratory test results of two patients with TRALI after blood transfusion were retrospectively analyzed, and human leukocyte antigen (HLA) genotyping of the patient and HLA antibodies typing of the plasma donors were performed. 【Results】 The clinical manifestations and laboratory parameters of two patients were consistent with those of TRALI after blood transfusion. After timely clinical respiratory support treatment, all patients were improved. Blood donors produced high titers of HLA-Ⅱ antibodies after pregnancy, including antibodies that specifically recognize the patient′s HLA antigen. 【Conclusion】 Two patients developed TRALI after platelet transfusion from a female blood donor, which was caused by HLA-Ⅱ antibodies.

Tirofiban interferes with antibody-mediated transfusion-related acute lung injury by inhibiting platelet-neutrophil binding / 中国输血杂志

【Objective】 To explore the feasibility of tirofiban, a platelet surface glycoprotein (GP)Ⅱb/Ⅲa receptor antagonist intervene in transfusion-related acute lung injury (TRALI), by inhibiting platelet activation and by preventing platelet and neutrophil binding to form aggregates. 【Methods】 1) Fifty wild-type male Balb/c mice, aged 8 to 10 weeks, were randomly divided into TRALI, normal, tirofiban TRALI intervention, isotype control and tirofiban normal intervention groups. In the TRALI model, tirofiban TRALI intervention and isotype control groups, each mouse was injected intraperitoneally with lipopolysaccharide (LPS) 0.1 mg/kg, and after 18 h with 4.5 mg/kg anti-MHC-I or IgG2a isotype control antibody, in which 0.5 μg/g tirofiban was injected 30 min before anti-MHC-I injection, and was labeled as tirofiban TRALI intervention. The group without any treatment was set as normal group. The tirofiban normal intervention group was injected with only 0.5 μg/g tirofiban into the tail vein, 30 min before the injection of anti-MHC-I. 2) After antibody injection, the mice were observed for 2 h, then executed with their lungs removed, and the extent of lung injury and the intervention effect of tirofiban were analyzed by comparing the differences in lung dry to wet ratio, total protein, myeloperoxidase (MPO), inflammatory factors and quantitative results of HE staining. The platelet activation level in whole blood and immunofluorescence (IF) quantification of platelet and neutrophil fluorescence were detected by flow cytometry to analyze the mechanism of tirofiban on TRALI. 【Results】 1) The indexes of lung injury in the tirofiban TRALI intervention group and TRALI model group for HE staining were 0.663 3±0.141 9 vs. 0.173 3±0.120 4 (P<0.05), respectively; 2) Platelet activation levels(%)in whole blood in the TRALI group, normal group and tirofiban TRALI intervention group were 22.87±9.943 vs 5.070±2.234 vs 5.767±3.224(P<0.05), respectively. 3) The mean fluorescence density of platelet neutrophil aggregates for IF detection in the tirofiban intervention group and TRALI model group was 21.89±3.536 vs. 32.77±0.9624 (P<0.05). 【Conclusion】 The platelet GP Ⅱ b/Ⅲa-specific inhibitor tirofiban inhibited platelet-neutrophil binding in mice, thus could possibly intervene in TRALI.

Potential of modulating fibrinolytic activity in intervention of transfusion-related acute lung injury / 中国输血杂志

Transfusion-related acute lung injury (TRALI), with clinical manifestation, diagnosis and pathological mechanism consistent with acute lung injury(ALI), belongs to a sub-category of ALI. Excessive deposition of fibrin in lung is one of the characteristic of ALI, and reversing fibrin formation is of great significance to intervene ALI. The decrease of fibrinolytic activity is one of the important causes of excessive deposition of fibrin in lung, and also the important pathological feature of TRALI. This article discusses the potential of modulating fibrinolytic activity to intervene TRALI from the perspective of regulating the effectiveness of fibrinolytic activity to intervene ALI.

Function of platelet-derived extracellular vesicles in adverse reactions to blood transfusion / 中国输血杂志

Recent studies have shown that a series of structural and functional changes would occur during the process of platelet collection, storage and transfusion. The storage of platelets would induce the production of extracellular vesicles. During the process of platelet transfusion, extracellular vesicles play a critical role by carrying diverse substances under various pathophysiological conditions, which causes adverse reactions to blood transfusion. Ceramide and soluble CD40L (sCD40L) carried by platelet-derived extracellular vesicles may lead to transfusion-related acute lung injury (TRALI). Extracellular vesicles containing mtDNA are considered as damage-associated molecular patterns (DAMPs), which can mediate local and systemic inflammation and promote inflammation through interactions with leukocytes and monocytes. Platelet derived extracellular vesicles contain lots of procoagulant substances, which are considered as prethrombotic substances. The RNA of varying species or content carried by vesicles during the process of platelet storage may also related to the occurrence of adverse reactions to blood transfusion.

Human Neutrophil Alloantigen-3a Alloimmunization among Pregnant Korean Women / 대한수혈학회지

BACKGROUND: Alloantibodies against human neutrophil alloantigen (HNA)-3a are associated with severe and fatal transfusion related acute lung injury (TRALI). HNA-3 genotyping and HNA-3a antibody (Ab) identification are essential to diagnosis and prevention of TRALI caused by HNA-3a Ab. However there had been no laboratory for HNA-3a Ab identification in Korea. The aims of this study were to establish the HNA-3a Ab test in Korea and to estimate the incidence of HNA-3a alloimmunization among pregnant Korean women. METHODS: HNA-3a homozygotes and HNA-3b homozygotes were identified by HNA-3 genotyping. Three HNA-3a homozygotes and three HNA-3b homozygotes are included in the granulocytes panel, which consisted of 10 donors for granulocytes. Sera from 650 pregnant Korean women were tested for granulocyte Ab using a mixed passive hemagglutination assay (MPHA). When a HNA-3a Ab was detected, the woman's HNA-3 was typed to support her HNA-3a alloimmunization. RESULTS: MPHA showed positive reactions in the sera from 26 women (4.0%, 26/650). HLA Abs were detected in 18 women (2.8%, 18/650), among whom HNA Abs were identified simultaneously in 7 women. Granulocyte Abs were detected in sera from 15 women (2.3%, 15/650). The incidence of HNA-3a, HNA-1b, HNA-1a, HNA-2a, and unidentified HNA Abs among pregnant Korean women was 0.77% (5/650), 0.77% (5/650), 0.62% (4/650), 0.15 (1/650), and 0.31% (2/650), respectively. CONCLUSION: In this study, we established the HNA-3a Ab test using MPHA for diagnosis and prevention of TRALI caused by HNA-3a Ab. The incidence of HNA-3a Ab in pregnant Korean women was 0.77% (5/650).

A Case Report of Transfusion-Related Acute Lung Injury Induced in the Patient with HLA Antibody after Fresh Frozen Plasma Transfusion / 대한수혈학회지

Development of transfusion-related acute lung injury (TRALI), a non-cardiogenic pulmonary edema, after blood transfusion, is a rare but potentially leading cause of mortality from blood transfusion. We report on a case of TRALI in a 51-year male with acute calculous cholecystitis and liver cirrhosis. As preoperative treatment, he was given ten units of fresh frozen plasma (FFP) for 3 days before the operation. During the transfusion of the 10th unit of FFP, he experienced a sudden onset of hemoptysis, tachypnea, tachycardia, and cyanosis. Bilateral pulmonary infiltration not observed on the chest X-ray at the visit was newly developed. There was no evidence of volume overload but severe hypoxemia. Blood transfusion was stopped and he recovered fully after 8 days of oxygen therapy through a nasal cannula. Although HLA and HNA antibodies were not detected in the donor's blood, HLA antibodies (A2, B57, B58) were detected in the patient's blood. We reported this meaningful case of TRALI that occurred after transfusion of only fresh frozen plasma which did not contain human leukocyte antibody in a patient with HLA antibody.

A case of transfusion-related acute lung injury induced by anti-human leukocyte antigen antibodies in acute leukemia

Transfusion-related acute lung injury (TRALI) is a noncardiogenic pulmonary edema that occurs during or within 6 hours after transfusion. Risk factors for TRALI, which is relatively common in critically ill patients, include recent surgery, hematologic malignancy, and sepsis. Here, we report a case of TRALI induced by anti-human leukocyte antigen (anti-HLA) class II antibodies (HLA-DR) occurring after transfusion of platelet concentrates in a patient with acute leukemia. Although most patients with TRALI show improvement within 48-96 hours, our patient's condition rapidly worsened, and he did not respond to supportive treatment. TRALI is a relatively common and serious adverse transfusion reaction that requires prompt diagnosis and management.

Two Cases of Transfusion-related Acute Lung Injury Triggered by HLA and Anti-HLA Antibody Reaction

Transfusion-related acute lung injury (TRALI) is a serious adverse transfusion reaction that is presented as acute hypoxemia and non-cardiogenic pulmonary edema, which develops during or within 6 hr of transfusion. Major pathogenesis of TRALI is known to be related with anti-HLA class I, anti-HLA class II, or anti-HNA in donor's plasma. However, anti-HLA or anti-HNA in recipient against transfused donor's leukocyte antigens also cause TRALI in minor pathogenesis and which comprises about 10% of TRALI. Published reports of TRALI are relatively rare in Korea. In our cases, both patients presented with dyspnea and hypoxemia during transfusion of packed red blood cells and showed findings of bilateral pulmonary infiltrations at chest radiography. Findings of patients' anti-HLA antibodies and recipients' HLA concordance indicate that minor pathogenesis may be not as infrequent as we'd expected before. In addition, second case showed that anti-HLA class II antibodies could be responsible for immunopathogenic mechanisms, alone.

Transfusion-Related Acute Lung Injury (TRALI) in Patients with Aneurysmal Subarachnoid Hemorrhage (SAH) / 대한뇌혈관외과학회지

OBJECTIVE: Transfusion-related acute lung injury (TRALI) is a poorly understood, but life-threatening complication after transfusion of blood components. The present study was conducted to identify the incidence of TRALI in patients with aneurysmal subarachnoid hemorrhage (SAH) as well as to determine the risk factors for TRALI. METHODS: This retrospective study was carried out on our institute, during the period of Jan. 2006 and Dec. 2008 to a total of 237 patients who underwent microsurgical treatment for aneurysmal SAH. In this time period, 154 patients were finally enrolled in this study. Patients' demographics, clinical and radiographic factors relevant to the aneurysms and SAH, and parameters regarding transfusion were analyzed and compared. RESULTS: A total of 9 patients had TRALI among a total of 154 patients. The incidence of TRALI was 0.01% (9 in 836) for all transfused blood component, and 0.06% (9 in 154) for all transfused patients. Statistical analysis showed that Fisher grade III and IV (OR, 1.88; 95% CI, 1.13-3.07) and total amount of transfused units exceeding 1,200cc (OR 1.72; 95% CI, 1.22-2.65) were associated with the development of TRALI. On the other hand, sex, poor Hunt-Hess Grade (IV and V), preoperative hemoglobin less than 13, postoperative hemoglobin less than 11, use of volume expander, premorbid disease (hypertension, diabetes) were not associated with TRALI. CONCLUSIONS: The results of present study indicate that large amount SAH and transfusion of blood components more than 1,200cc are risk factors for the development of TRALI. Prospectively designed study with a larger cohort is mandated to confirm the etiology and risk factors of TRALI in stroke practice.

Transfusion related acute lung injury occurred in HLA half-matched hematopoietic stem cell transplantation:a case report and literature review / 中国输血杂志

Objective To clarify the risk,treatment and preventive measurement of transfusion related acute lung injury (TRALI) occurred in HLA half-matched hematopoietic stem cell transplantation. Methods A case of TRALI occurred in HLA half-matched hematopoietic stem cell transplantation was analyzed,including the clinical characteristics,the laboratory and instrumental examination,the treatment measure and prognosis,and then the associated literature was reviewed.Results Owing to the blood products(fresh platelet) transfusion during transplantation,the patient got TRALI. And after active rescue,the patient eventually died due to the worsen condition.Conclusion The risk of TRALI is very high in HLA half-matched hematopoietic stem cell transplantation since the blood products transfusion is inevitable,so the effective and timely treatment and preventive measurement are necessary.

A Case of Transfusion-related Acute Lung Injury / 대한수혈학회지

Transfusion-related acute lung injury (TRALI) is defined as a new episode of acute lung injury that occurs during or within 6 hours of a completed transfusion, which has been the leading cause of transfusion-related death. We report a case of TRALI in a 63-year old man with alcoholic liver disease. He developed hypoxemia and non-cardiogenic pulmonary edema after red blood cell transfusion. Given an oxygen support, he recovered after 4 days.