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Adverse Occurrence type:
Annual TRALI incidence decreased from 2.57 per 10,000 units in 2006 to 0.81 per 10,000 in 2009 as a result of reduced transfusion of plasma from female donors.
Time to detection:
< 6 hours
Alerting signals, symptoms, evidence of occurrence:
Eighty nine TRALI cases per 463,207 blood and blood component transfusions. Seventy received one or more high plasma volume blood products. Annual TRALI incidence decreased from 2.57 per 10,000 units in 2006, to 0.81 per 10,000 in 2009 as a result of reduced transfusion of plasma from female donors. No evidence that longer stored units (all leukocyte-reduced) was a risk factor. Receipt of whole blood or plasma from female donors increased risk (OR= 4.5). Larger volume transfusions with strong cognate anti-HLA Class II antibodies and volumes of anti-human neutrophil antibodies increased risk (OR=1.92 per 100mL for strong anti- HLA Class II) OR= 1.71 for volume of anti-HNA by granulocyte IFA. Class II antibodies more important than Class I. Substantial risk not found from non-cognate antibody or bioreactive substances. Patient risk factors were important predictors of TRALI and included: shock, liver surgery (mainly transplantation), chronic alcohol abuse, positive fluid balance, peak airway pressure >30cm H2O if ventilated prior to transfusion, current smoking, and higher patient plasma IL-8 prior to transfusion.
Demonstration of imputability or root cause:
Expert review of cases within 72 hours. Surveillance of arterial blood gas determinations PaO2/FiO2<300mmHg. TRALI defined as new ALI within 6 hours of transfusion. Patiens with known causes of ALI were excluded. Study designed to detect TRALI cases with severe enough hypoxemia for arterial blood gases to be obtained.
Toy P, Gajic O, Bacchetti P, Looney MR, Gropper MA, Hubmayr R, Lowell CA, Norris PJ, Murphy EL, Weiskopf RB, Wilson G, Koenigsberg M, Lee D, Schuller R, Wu P, Grimes B, Gandhi MJ, Winters JL, Mair D, Hirschler N, Sanchez Rosen R, Matthay MA; TRALI Study Group. Transfusion-related acute lung injury: incidence and risk factors. Blood. 2012;119:1757-67.
Expert comments for publication:
Two academic medical centers (UCSF and Mayo Clinic). Active surveillance and case-control study design.