Record number:
1092
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Rare
Time to detection:
<6 hours
Alerting signals, symptoms, evidence of occurrence:
Recurrent TRALI in a 43-year-old post-hysterectomy female patient. She was transfused with 3 units of plasma-reduced RBCs for anemia, developed dyspnea, reduced oxygen saturation (76%), and lungs were stiff for ventillation. She then received 3 units of FFP and 3 additional plasma-reduced RBCs. Chest x-ray showed bilateral pulmonary infiltrates consistent with TRALI. By day 5 she recovered. She was then given 2 additional plasma-reduced RBCs and developed dysnea and severe hypoxemia, chest x-ray consistent with second episode of TRALI. Lab investigation showed presence of HLA-A2 (N=1) antibodies and granulocyte-specific IgM antibodies (N=2) in sera from three of the donors from the first TRALI episode. All three sera reacted in crossmatch with patient's granulocytes and lymphocytes. No evidence of WBC antibody involvement in the second TRALI episode. Second episode attributed to lipid neurtrophil-priming agents in donor units in association with donor's underlying pulmonary condition, as she was recovering from lung injury.
Demonstration of imputability or root cause:
TRALI criteria met, confirmed incompatibility of donors sera containing HLA-A2 antibodies and granulocyte-specific antibodies with recipients cells.
Keywords:
References:
Suggest references:
Win, N., Montgomery, J., Sage, D., Street, M, and Duncan, J. (2001). Recurrent transfusion-related acute lung injury. Transfusion 41:1421-1425.