TRALI (Transfusion-related acute lung injury)

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.