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Testing only donors with a prior history of pregnancy or transfusion is a logical and cost‐effective transfusion‐related acute lung injury prevention strategy
Author(s) -
Powers Amy,
Stowell Christopher P.,
Dzik Walter H.,
Saidman Susan L.,
Lee Hang,
Makar Robert S.
Publication year - 2008
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2008.01902.x
Subject(s) - medicine , transfusion related acute lung injury , pregnancy , retrospective cohort study , human leukocyte antigen , obstetrics , confidence interval , immunology , lung , antigen , pulmonary edema , biology , genetics
BACKGROUND: Transfusion‐related acute lung injury (TRALI) is the leading cause of transfusion‐related fatality reported to the Food and Drug Administration. Donor screening may reduce TRALI risk. This study sought to compare the efficacy and safety of different TRALI risk‐reduction strategies at a hospital‐based donor center. STUDY DESIGN AND METHODS: Samples from 1053 donors who answered questions regarding pregnancy and transfusion history were tested for HLA Class I and II antibodies using a flow cytometry–based screening assay. Donor history was compared with the presence of HLA alloantibodies. These data were used to model several TRALI risk‐reduction strategies. The medical records of patients transfused fresh‐frozen plasma (FFP) from highly alloimmunized donors were retrospectively reviewed for TRALI. RESULTS: HLA alloimmunization was observed among 25.4 percent (256/1009) of all female donors and among 12.0 percent (3/25) of those male donors who gave a history of prior transfusion. Prior pregnancy, reported by 52.6 percent (531/1009) of females, correlated significantly with HLA alloimmunization (p < 0.0001). The rate of HLA alloimmunization increased with parity. A positive pregnancy history was a sensitive (87.9%) screen for HLA alloimmunization with a negative predictive value of 93.5 percent (95% confidence interval, 91.3%‐95.7%). Although 5.9 percent (27/459) of nulliparous, untransfused females demonstrated a positive screening test, only 1 percent (7/459) had a confirmed HLA alloantibody. Transfusion of FFP from donors found retrospectively to be highly alloimmunized led to reactions suggestive of TRALI in 2 of 26 recipients. CONCLUSIONS: Donor history is a reliable predictor of HLA alloimmunization. Testing only donors with a prior history of pregnancy or transfusion is a logical and cost‐effective TRALI prevention strategy.