Alloexposed blood donors and transfusion-related acute lung injury: a case-referent study
Rutger A. Middelburg
From the Department of Clinical Epidemiology, Leiden University Medical Center, and Sanquin-LUMC Jon J. van Rood Center for Clinical Transfusion Research, Leiden; the Department of Research and Training, Sanquin Blood Bank, Dordrecht and Nijmegen; TRIP (Transfusion Reactions in Patients) Dutch National Hemovigilance Office, The Hague; Sanquin Diagnostic Services, Amsterdam; and Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, The Netherlands.
Search for more papers by this authorDaniëlle van Stein
From the Department of Clinical Epidemiology, Leiden University Medical Center, and Sanquin-LUMC Jon J. van Rood Center for Clinical Transfusion Research, Leiden; the Department of Research and Training, Sanquin Blood Bank, Dordrecht and Nijmegen; TRIP (Transfusion Reactions in Patients) Dutch National Hemovigilance Office, The Hague; Sanquin Diagnostic Services, Amsterdam; and Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, The Netherlands.
Search for more papers by this authorFemke Atsma
From the Department of Clinical Epidemiology, Leiden University Medical Center, and Sanquin-LUMC Jon J. van Rood Center for Clinical Transfusion Research, Leiden; the Department of Research and Training, Sanquin Blood Bank, Dordrecht and Nijmegen; TRIP (Transfusion Reactions in Patients) Dutch National Hemovigilance Office, The Hague; Sanquin Diagnostic Services, Amsterdam; and Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, The Netherlands.
Search for more papers by this authorJohanna C. Wiersum-Osselton
From the Department of Clinical Epidemiology, Leiden University Medical Center, and Sanquin-LUMC Jon J. van Rood Center for Clinical Transfusion Research, Leiden; the Department of Research and Training, Sanquin Blood Bank, Dordrecht and Nijmegen; TRIP (Transfusion Reactions in Patients) Dutch National Hemovigilance Office, The Hague; Sanquin Diagnostic Services, Amsterdam; and Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, The Netherlands.
Search for more papers by this authorLeendert Porcelijn
From the Department of Clinical Epidemiology, Leiden University Medical Center, and Sanquin-LUMC Jon J. van Rood Center for Clinical Transfusion Research, Leiden; the Department of Research and Training, Sanquin Blood Bank, Dordrecht and Nijmegen; TRIP (Transfusion Reactions in Patients) Dutch National Hemovigilance Office, The Hague; Sanquin Diagnostic Services, Amsterdam; and Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, The Netherlands.
Search for more papers by this authorErik A.M. Beckers
From the Department of Clinical Epidemiology, Leiden University Medical Center, and Sanquin-LUMC Jon J. van Rood Center for Clinical Transfusion Research, Leiden; the Department of Research and Training, Sanquin Blood Bank, Dordrecht and Nijmegen; TRIP (Transfusion Reactions in Patients) Dutch National Hemovigilance Office, The Hague; Sanquin Diagnostic Services, Amsterdam; and Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, The Netherlands.
Search for more papers by this authorErnest Briët
From the Department of Clinical Epidemiology, Leiden University Medical Center, and Sanquin-LUMC Jon J. van Rood Center for Clinical Transfusion Research, Leiden; the Department of Research and Training, Sanquin Blood Bank, Dordrecht and Nijmegen; TRIP (Transfusion Reactions in Patients) Dutch National Hemovigilance Office, The Hague; Sanquin Diagnostic Services, Amsterdam; and Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, The Netherlands.
Search for more papers by this authorCorresponding Author
Johanna G. van der Bom
From the Department of Clinical Epidemiology, Leiden University Medical Center, and Sanquin-LUMC Jon J. van Rood Center for Clinical Transfusion Research, Leiden; the Department of Research and Training, Sanquin Blood Bank, Dordrecht and Nijmegen; TRIP (Transfusion Reactions in Patients) Dutch National Hemovigilance Office, The Hague; Sanquin Diagnostic Services, Amsterdam; and Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, The Netherlands.
Johanna G. van der Bom, Leiden University Medical Center (LUMC), Clinical Epidemiology, Postzone C7-P, PO Box 9600, 2300 RC Leiden, The Netherlands; e-mail: [email protected]. Search for more papers by this authorRutger A. Middelburg
From the Department of Clinical Epidemiology, Leiden University Medical Center, and Sanquin-LUMC Jon J. van Rood Center for Clinical Transfusion Research, Leiden; the Department of Research and Training, Sanquin Blood Bank, Dordrecht and Nijmegen; TRIP (Transfusion Reactions in Patients) Dutch National Hemovigilance Office, The Hague; Sanquin Diagnostic Services, Amsterdam; and Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, The Netherlands.
Search for more papers by this authorDaniëlle van Stein
From the Department of Clinical Epidemiology, Leiden University Medical Center, and Sanquin-LUMC Jon J. van Rood Center for Clinical Transfusion Research, Leiden; the Department of Research and Training, Sanquin Blood Bank, Dordrecht and Nijmegen; TRIP (Transfusion Reactions in Patients) Dutch National Hemovigilance Office, The Hague; Sanquin Diagnostic Services, Amsterdam; and Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, The Netherlands.
Search for more papers by this authorFemke Atsma
From the Department of Clinical Epidemiology, Leiden University Medical Center, and Sanquin-LUMC Jon J. van Rood Center for Clinical Transfusion Research, Leiden; the Department of Research and Training, Sanquin Blood Bank, Dordrecht and Nijmegen; TRIP (Transfusion Reactions in Patients) Dutch National Hemovigilance Office, The Hague; Sanquin Diagnostic Services, Amsterdam; and Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, The Netherlands.
Search for more papers by this authorJohanna C. Wiersum-Osselton
From the Department of Clinical Epidemiology, Leiden University Medical Center, and Sanquin-LUMC Jon J. van Rood Center for Clinical Transfusion Research, Leiden; the Department of Research and Training, Sanquin Blood Bank, Dordrecht and Nijmegen; TRIP (Transfusion Reactions in Patients) Dutch National Hemovigilance Office, The Hague; Sanquin Diagnostic Services, Amsterdam; and Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, The Netherlands.
Search for more papers by this authorLeendert Porcelijn
From the Department of Clinical Epidemiology, Leiden University Medical Center, and Sanquin-LUMC Jon J. van Rood Center for Clinical Transfusion Research, Leiden; the Department of Research and Training, Sanquin Blood Bank, Dordrecht and Nijmegen; TRIP (Transfusion Reactions in Patients) Dutch National Hemovigilance Office, The Hague; Sanquin Diagnostic Services, Amsterdam; and Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, The Netherlands.
Search for more papers by this authorErik A.M. Beckers
From the Department of Clinical Epidemiology, Leiden University Medical Center, and Sanquin-LUMC Jon J. van Rood Center for Clinical Transfusion Research, Leiden; the Department of Research and Training, Sanquin Blood Bank, Dordrecht and Nijmegen; TRIP (Transfusion Reactions in Patients) Dutch National Hemovigilance Office, The Hague; Sanquin Diagnostic Services, Amsterdam; and Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, The Netherlands.
Search for more papers by this authorErnest Briët
From the Department of Clinical Epidemiology, Leiden University Medical Center, and Sanquin-LUMC Jon J. van Rood Center for Clinical Transfusion Research, Leiden; the Department of Research and Training, Sanquin Blood Bank, Dordrecht and Nijmegen; TRIP (Transfusion Reactions in Patients) Dutch National Hemovigilance Office, The Hague; Sanquin Diagnostic Services, Amsterdam; and Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, The Netherlands.
Search for more papers by this authorCorresponding Author
Johanna G. van der Bom
From the Department of Clinical Epidemiology, Leiden University Medical Center, and Sanquin-LUMC Jon J. van Rood Center for Clinical Transfusion Research, Leiden; the Department of Research and Training, Sanquin Blood Bank, Dordrecht and Nijmegen; TRIP (Transfusion Reactions in Patients) Dutch National Hemovigilance Office, The Hague; Sanquin Diagnostic Services, Amsterdam; and Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, The Netherlands.
Johanna G. van der Bom, Leiden University Medical Center (LUMC), Clinical Epidemiology, Postzone C7-P, PO Box 9600, 2300 RC Leiden, The Netherlands; e-mail: [email protected]. Search for more papers by this authorAbstract
BACKGROUND: Donor white blood cell (WBC) antibodies are thought to increase the risk of transfusion-related acute lung injury (TRALI). WBC antibodies can be present in blood products from donors who have been alloexposed. Alloexposed donors are increasingly excluded from donating plasma, but can still donate plasma-poor products. We aimed to quantify the contribution of alloexposed donors to the occurrence of TRALI for different blood product types.
STUDY DESIGN AND METHODS: We performed a case-referent study including all reported TRALI patients and all Dutch blood donors. Data on alloexposure status of donors of all TRALI cases reported between January 2004 and October 2008, in the Netherlands, were compared to information on the total donor population.
RESULTS: Alloexposure status of all 223 involved donors was compared to the expected status. The overall percentage of TRALI cases that could have been prevented by the deferral of all alloexposed donors (i.e., population-attributable risk [PAR]) was 51% (95% confidence interval [CI], 14%-88%). In 19 recipients of exclusively plasma-poor products (mostly red blood cells [RBCs]), alloexposure of the donors was not associated with TRALI, while in 28 recipients of both plasma-poor and plasma-rich products (>200 mL plasma), the PAR was 94% (95% CI, 34%-100%).
CONCLUSIONS: Alloexposed donors conferred an increased risk of TRALI in recipients of plasma-rich products, but not in recipients of plasma-poor products. Although WBC antibodies are an important risk factor for TRALI, among RBC recipients another risk factor must be more important.
Supporting Information
Appendix S1. Alloexposure verification of donors of TRALI patients and reference subjects.
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Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- 1 Goldman M, Webert KE, Arnold DM, Freedman J, Hannon J, Blajchman MA. Proceedings of a consensus conference: towards an understanding of TRALI. Transfus Med Rev 2005; 19: 2-31.
- 2 Kleinman S, Caulfield T, Chan P, Davenport R, McFarland J, McPhedran S, Meade M, Morrison D, Pinsent T, Robillard P, Slinger P. Toward an understanding of transfusion-related acute lung injury: statement of a consensus panel. Transfusion 2004; 44: 1774-89.
- 3 Popovsky MA, Moore SB. Diagnostic and pathogenetic considerations in transfusion-related acute lung injury. Transfusion 1985; 25: 573-7.
- 4 Moore SB. Transfusion-related acute lung injury (TRALI): clinical presentation, treatment, and prognosis. Crit Care Med 2006; 34(5 Suppl): S114-7.
- 5 Wallis JP. Transfusion-related acute lung injury (TRALI): presentation, epidemiology and treatment. Intensive Care Med 2007; 33(Suppl 1): S12-6.
- 6 SHOT. Serious Hazards of Transfusion (SHOT): SHOT annual report 2004. 2006. [cited 2006 Oct 16]. Available from: URL: http://www.shotuk.org
- 7 TRIP. “Transfusie Reacties in Patiënten” (TRIP): TRIP rapport 2008. 2010. [cited 2010 Jan 19]. Available from: URL: http://www.tripnet.nl/
- 8 Engelfriet CP. Haemovigilance. Vox Sang 2006; 90: 207-41.
- 9 Middelburg RA, van Stein D, Briet E, van der Bom JG. The role of donor antibodies in the pathogenesis of transfusion-related acute lung injury: a systematic review. Transfusion 2008; 48: 2167-76.
- 10 Bux J. Transfusion-related acute lung injury (TRALI): a serious adverse event of blood transfusion. Vox Sang 2005; 89: 1-10.
- 11 Dry SM, Bechard KM, Milford EL, Churchill WH, Benjamin RJ. The pathology of transfusion-related acute lung injury. Am J Clin Pathol 1999; 112: 216-21.
- 12 Kopko PM. Review: transfusion-related acute lung injury: pathophysiology, laboratory investigation, and donor management. Immunohematol 2004; 20: 103-11.
- 13 Silliman CC, Boshkov LK, Mehdizadehkashi Z, Elzi DJ, Dickey WO, Podlosky L, Clarke G, Ambruso DR. Transfusion-related acute lung injury: epidemiology and a prospective analysis of etiologic factors. Blood 2003; 101: 454-62.
- 14 Boulton-Jones R, Norris A, O'Sullivan A, Comrie A, Forgan M, Rawlinson PS, Clark P. The impact of screening a platelet donor panel for human leucocyte antigen antibodies to reduce the risk of transfusion-related acute lung injury. Transfus Med 2003; 13: 169-70.
- 15 Densmore TL, Goodnough LT, Ali S, Dynis M, Chaplin H. Prevalence of HLA sensitization in female apheresis donors. Transfusion 1999; 39: 103-6.
- 16 Payne R. The development and persistence of leukoagglutinins in parous women. Blood 1962; 19: 411-24.
- 17 Triulzi DJ, Kleinman S, Kakaiya RM, Busch MP, Norris PJ, Steele WR, Glynn SA, Hillyer CD, Carey P, Gottschall JL, Murphy EL, Rios JA, Ness PM, Wright DJ, Carrick D, Schreiber GB. The effect of previous pregnancy and transfusion on HLA alloimmunization in blood donors: implications for a transfusion-related acute lung injury risk reduction strategy. Transfusion 2009; 49: 1825-35.
- 18 Reil A, Keller-Stanislawski B, Gunay S, Bux J. Specificities of leucocyte alloantibodies in transfusion-related acute lung injury and results of leucocyte antibody screening of blood donors. Vox Sang 2008; 95: 313-7.
- 19 Powers A, Stowell CP, Dzik WH, Saidman SL, Lee H, Makar RS. Testing only donors with a prior history of pregnancy or transfusion is a logical and cost-effective transfusion-related acute lung injury prevention strategy. Transfusion 2008; 48: 2549-58.
- 20 Sachs UJ. Pathophysiology of TRALI: current concepts. Intensive Care Med 2007; 33(Suppl 1): S3-11.
- 21 Cherry T, Steciuk M, Reddy VV, Marques MB. Transfusion-related acute lung injury: past, present, and future. Am J Clin Pathol 2008; 129: 287-97.
- 22 Jutzi ML. Swiss haemovigilance data and implementation of measures for the prevention of transfusion associated acute lung injury (TRALI). Transfus Med Hemother 2008; 35: 98-101.
- 23 Wright SE, Snowden CP, Athey SC, Leaver AA, Clarkson JM, Chapman CE, Roberts DR, Wallis JP. Acute lung injury after ruptured abdominal aortic aneurysm repair: the effect of excluding donations from females from the production of fresh frozen plasma. Crit Care Med 2008; 36: 1796-802.
- 24 Chapman CE, Stainsby D, Jones H, Love E, Massey E, Win N, Navarrete C, Lucas G, Soni N, Morgan C, Choo L, Cohen H, Williamson LM; Serious Hazards of Transfusion Steering Group. Ten years of hemovigilance reports of transfusion-related acute lung injury in the United Kingdom and the impact of preferential use of male donor plasma. Transfusion 2008; 49: 440-52.
- 25 SHOT. Serious Hazards of Transfusion (SHOT): SHOT annual report 2008. 2009. [cited 2010 Jan 19]. Available from: URL: http://www.shotuk.org
- 26 Middelburg RA, van Stein D, Zupanska B, Uhrynowska M, Gajic O, Muniz-Diaz E, Nogués Galvez N, Silliman CC, Krusius T, Wallis J, Vandenbroucke JP, Briët E, Van Der Bom JG. Female donors and transfusion-related acute lung injury: a case-referent study from the International TRALI Unisex Research Group. Transfusion 2010; 50: 2447-554.
- 27 Middelburg RA, LeCessie S, Briët E, Vanderbroucke JP, van der Bom JG. A solution to the problem of studying blood donor related risk factors when patient have received multiple transfusions. Transfusion 2010; 50: 1959-66.
- 28 Win N, Chapman CE, Bowles KM, Green A, Bradley S, Edmondson D, Wallis JP. How much residual plasma may cause TRALI? Transfus Med 2008; 18: 276-80.
- 29 Rothman KJ, Greenland S, Walker AM. Concepts of interaction. Am J Epidemiol 1980; 112: 467-70.
- 30 Wiersum-Osselton JC, Middelburg RA, Becker EA, van Tilborgh AJ, Zijlker-Jansen PY, Brand A, van der Bom JG, Schipperus MR. Male-only fresh-frozen plasma for transfusion-related acute lung injury prevention: before-and-after comparative cohort study. Transfusion 2011; 51: 1278-83.
- 31 Middelburg RA, Porcelijn L, Lardy N, Briet E, Vrielink H. Prevalence of leucocyte antibodies in the Dutch donor population. Vox Sang 2010. 10-0410.
- 32 Silliman CC, Paterson AJ, Dickey WO, Stroneck DF, Popovsky MA, Caldwell SA, Ambruso DR. The association of biologically active lipids with the development of transfusion-related acute lung injury: a retrospective study. Transfusion 1997; 37: 719-26.
- 33 Silliman CC, Fung YL, Bradley BJ, Khan SY. Transfusion-related acute lung injury (TRALI): current concepts and misconceptions. Blood Rev 2009; 23: 245-55.
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