Volume 47, Issue 4 pp. 599-607

Transfusion-related acute lung injury surveillance (2003-2005) and the potential impact of the selective use of plasma from male donors in the American Red Cross

Anne F. Eder

Anne F. Eder

From the Biomedical Services, National Headquarters, American Red Cross Blood Services, Washington, DC; the Jerome H. Holland Laboratory, Rockville, Maryland; and the Blood Bank of San Bernardino and Riverside Counties, San Bernardino, California.

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Ross Herron

Ross Herron

From the Biomedical Services, National Headquarters, American Red Cross Blood Services, Washington, DC; the Jerome H. Holland Laboratory, Rockville, Maryland; and the Blood Bank of San Bernardino and Riverside Counties, San Bernardino, California.

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Annie Strupp

Annie Strupp

From the Biomedical Services, National Headquarters, American Red Cross Blood Services, Washington, DC; the Jerome H. Holland Laboratory, Rockville, Maryland; and the Blood Bank of San Bernardino and Riverside Counties, San Bernardino, California.

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Beth Dy

Beth Dy

From the Biomedical Services, National Headquarters, American Red Cross Blood Services, Washington, DC; the Jerome H. Holland Laboratory, Rockville, Maryland; and the Blood Bank of San Bernardino and Riverside Counties, San Bernardino, California.

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Edward P. Notari

Edward P. Notari

From the Biomedical Services, National Headquarters, American Red Cross Blood Services, Washington, DC; the Jerome H. Holland Laboratory, Rockville, Maryland; and the Blood Bank of San Bernardino and Riverside Counties, San Bernardino, California.

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Linda A. Chambers

Linda A. Chambers

From the Biomedical Services, National Headquarters, American Red Cross Blood Services, Washington, DC; the Jerome H. Holland Laboratory, Rockville, Maryland; and the Blood Bank of San Bernardino and Riverside Counties, San Bernardino, California.

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Roger Y. Dodd

Roger Y. Dodd

From the Biomedical Services, National Headquarters, American Red Cross Blood Services, Washington, DC; the Jerome H. Holland Laboratory, Rockville, Maryland; and the Blood Bank of San Bernardino and Riverside Counties, San Bernardino, California.

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Richard J. Benjamin

Richard J. Benjamin

From the Biomedical Services, National Headquarters, American Red Cross Blood Services, Washington, DC; the Jerome H. Holland Laboratory, Rockville, Maryland; and the Blood Bank of San Bernardino and Riverside Counties, San Bernardino, California.

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First published: 11 January 2007
Citations: 202
Anne Eder, MD, PhD, Biomedical Services, National Headquarters, American Red Cross, 2025 E Street NW, Washington, DC 20006; e-mail: [email protected].

Abstract

BACKGROUND: American Red Cross surveillance data on transfusion-related acute lung injury (TRALI) fatalities were analyzed to evaluate the association with components from donors with white blood cell (WBC) antibodies and to examine the potential impact of the selective transfusion of plasma from male donors.

STUDY DESIGN AND METHODS: Suspected TRALI reports in 2003 through 2005 were identified and all fatalities were reviewed and classified by three physicians as “probable TRALI” or of “unrelated etiology,” with independent review of the associated serologic investigation. Hospital investigational and reporting biases could not be fully controlled in this retrospective study.

RESULTS: A total of 550 reports of suspected TRALI, including 72 fatalities, were investigated. The number of reports increased each year and the rate varied by geographic region. Retrospective review of fatalities revealed 38 cases of probable TRALI, the majority (24 of 38 [63%]) after plasma transfusion. A female, WBC antibody–positive donor was involved in 71 percent (27 of 38) of cases and in 75 percent (18 of 24) of cases involving plasma transfusion. Female antibody-positive donors were more likely to be associated with probable TRALI than with unrelated cases (p = 0.0001; odds ratio [OR], 9.5; 95% confidence interval [CI], 2.9-31.1]. The rate of probable TRALI among recipient fatalities was higher for plasma components (1:202,673; OR, 12.5; 95% CI, 5.4-28.9) and apheresis platelets (PLTs; 1:320,572; OR, 7.9; 95% CI, 2.5-24.8) compared to red cells (1:2,527,437). Male donors contributed 64.5 and 52.0 percent of distributed apheresis PLTs and plasma components, respectively, in 2005.

CONCLUSION: Plasma components linked to female donors with WBC antibodies were responsible for the majority of probable TRALI fatalities. Prudent measures to limit transfusion of WBC antibody–containing plasma components may prevent as many as six fatalities per year in the Red Cross system.

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