Wednesday, January 18, 2012

From Michael Matthay and colleagues: Transfusion-related acute lung injury

Blood. 2011 Nov 23. [Epub ahead of print]
Transfusion related acute lung injury: incidence and risk factors.
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.
University of California, San Francisco, San Francisco, CA, United States;

Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. To determine TRALI incidence by prospective, active surveillance and to identify risk factors by a case-control study, two academic medical centers enrolled 89 cases and 164 transfused controls. Recipient risk factors identified by multivariate analysis were higher interleukin-8 levels, liver surgery, chronic alcohol abuse, shock, higher peak airway pressure while being mechanically ventilated, current smoking and positive fluid balance. Transfusion risk factors were receipt of plasma or whole blood from female donors (OR 4.5, 95% CI 1.85 to 11.2, p=0.001), volume of HLA Class II antibody with NBG > 27.5, (OR 1.92 per 100 mL, 95% CI 1.08 to 3.4, p=0.03), and volume of anti-HNA positive by GIFT (OR=1.71 per 100 mL, 95% CI 1.18 to 2.5, p=0.004). Little or no risk was associated with older red blood cell units, non-cognate or weak cognate Class II antibody, or Class I antibody. Reduced transfusion of plasma from female donors was concurrent with reduced TRALI incidence: 2.57 (95% CI 1.72 to3.86) in 2006 vs. 0.81 (95% CI 0.44 to1.49) in 2009 per 10,000 transfused units (p = 0.002). The identified risk factors provide potential targets for reducing residual TRALI.

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