A Case of Probable TRALI from Pooled Buffy Coat Platelets Containing Anti-HLA Antibodies

Abstract

Background/Case Studies:Ttransfusion-related acute lung injury (TRALI)is a potentially life-threatening complication of transfusion. The most widelyheld pathogenesis theory is that human leukocyte antigen (HLA) or humanneutrophil antigen (HNA) antibodies found in the donor’s plasma are directedagainst the recipient’s leukocyte antigen. We present a case of TRALI inwhich incompatible HLA class I and class II antibodies were identified in theimplicated donor.Study Design/Methods:The patient was genotyped forHLA class I and class II and for HNA 1-5 systems. HLA class I and class IIantibodies were analyzed by ELISA. HNA antibodies were investigated byimmunofluorescence test and agglutination test. The specificity of the HLAantibodies was investigated by bead-based technology (Luminex).Results/Findings:A 79-y-old female with myelodysplastic syndrome received atransfusion of INTERCEPT platelets; half an hour later, the patient experi-enced dyspnea, lumbar pain, and tachycardia (heart rate increased from 97to 130 bpm). The transfusion was interrupted; approximately 150 mL hadbeen transfused. The patient’s oxygen saturation was 89% (by pulse oxim-eter), and chest X-ray revealed bilateral pulmonary infiltrates. The patientwas treated with mechanical ventilation, steroids, and diuretics. Sheremained in the hospital until she died 6 days after the event. The plateletcomponent (a buffy coat pool from five donors) suspended in SSP+(35 %plasma carryover) was processed with the INTERCEPT Blood System (IBS).One donor was female with no history of pregnancy or transfusion, and fourdonors were male. One donor had a history of transfusion 18 y earlier; thatdonor had anti-HLA class I antibodies (49% positive), anti-HLA class IIantibodies (91% positive), and anti-granulocytes (weak positive). The donorwas positive for multiple anti-HLA antibodies to antigens present in therecipient (B50, B44, DR7, DR13, DQ2, and DQ5). Blood culture of theplatelet component was negative.Conclusion:The information providedappears to indicate that one of the donors, a previously transfused male, hadmultiple antibodies to HLA class II antigens that were present in the recipient.These findings would be consistent with an immunologic cause of TRALI.Volume of plasma is a risk factor, but, in this case, a small volume (only∼20 mL from a single donor) with potent antibodies would be enough to inciteTRALI from a pooled product