How do we investigate and manage donors associated with a suspected case of transfusion‐related acute lung injury

SUMMARY Overall, there are several components that we believe arecriticalforthesuccessfulinvestigationofasuspectedcaseof TRALI. One is verbal communication with the hospitaltransfusion service and the clinicians taking care of thepatient, the importance of which can not be overstated.Data that may be missed or understated on a form areoften made clear when questions are asked directly to theclinician. Additionally, communication with the clinicalstaff improves TRALI education and awareness andstreamlinesthereportingoffuturesuspectedTRALIcases.In short, verbal communication with the hospital trans-fusion service and clinical staff facilitates a timely andthorough investigation. It also ensures the capture ofvital information that assists in the clinical diagnosisand donor management of suspected TRALI cases.Equallyimportantisaclinicalclassicationthatisconsis-tent with what other institutions are using to documentcases of TRALI. To better understand TRALI, larger casenumbers need to be analyzed and studied, and onlythrough consistent reporting and classication can thisbe accomplished. We currently rely on the working de-nition recommended by the Canadian consensusconference panel for TRALI and possible TRALI. We havemade some modications to the Canadian consensusconference panel for our classications, but these modi-cations are for the purposes of donor management only.Aslongascompletedocumentationismaintained,theuseof these modications should not affect our ability toshare data with other institutions that do not use similarmodications.Despite our best efforts to establish a consistent andeffective way to manage suspectedTRALI cases, the man-agement of donors associated withTRALI remains a dif-cult task given that TRALI remains an incompletelyunderstood reaction. Contributing to the problem is theinconsistent recognition and reporting ofTRALI that con-tinues to occur from the bedside to the collecting facility,anissuethatultimatelyhampersthebloodcenters’abilityto recognize and prevent potentialTRALI reactions.Thereis great promise that reporting of suspectedTRALI eventswillimprovesignicantlyoncetheAABB’seffortstoestab-lish a US hemovigilance system come to fruition. Weexpect that these efforts will have similar success to pro-gramsalreadyestablishedinternationally.AUShemovigi-lance system will make great strides in improving datacollection and may provide new insight into additionalrisk factors for TRALI in donors.The approach described has been in place for UnitedBlood Services since 2006 and thus far has been effectiveat providing a consistent framework to ourTRALI investi-gations. Over the past several years, we have investigatedapproximately 30 to 40 suspected cases ofTRALI per year.In 2007, we have had 10 TRALI investigations to date, ofwhich 2 were classied as TRALI or likely to be TRALI.Sinceimplementationofournewapproach,donortestinghas been reduced from previous years; this is a result ofmore selective donor testing under the newly designedalgorithm. In the past, only donors with antibody toHNA-3a (5b) were deferred. Now, with the criteria fordonordeferralexpanded,implementationofthisprotocolhas resulted in the deferral of more donors.Our approach represents only one of many potentialways to handle donors associated with TRALI. To whatdegreeadonoristrulyatriskforcausingTRALIisnotwellknown and thus accounts for the variability in possiblestrategies. Nevertheless, our current approach representswhat we believe to be an effective and judicious strategy