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Residual plasma in red blood cells and transfusion‐related acute lung injury
Author(s) -
Weber Litchia L.,
Roberts Laura D.,
Sweeney Joseph D.
Publication year - 2014
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/trf.12662
Subject(s) - antibody , medicine , antigen , human leukocyte antigen , red blood cell , blood transfusion , transfusion related acute lung injury , immunology , residual risk , packed red blood cells , gastroenterology , whole blood , lung , andrology , chemistry , pulmonary edema
Background Transfusion‐related acute lung injury ( TRALI ) is the most common cause of death from blood transfusion and red blood cells ( RBCs ) now account for approximately 50% of these fatalities. RBC s from female donors have been implicated in large series and HLA C lass II antibodies to cognate recipient antigens identified in small series and case reports. The absolute volume of residual plasma in these RBC s is unknown. Study Design and Methods Two confirmed cases of RBC ‐associated TRALI in which the implicated donors had C lass II antibodies were investigated, and the antibody strength against recipient cognate antigens was assessed using a fluorescent bead assay. RBC s in additive solution ( AS ) were studied on D ay 42 of liquid storage to calculate residual anticoagulated plasma. Results Both RBC units were stored in AS ‐1 and were from female donors who had anti‐ HLA Class II antibodies of high strength against cognate antigens in the recipients. Anti‐ DR 4 was identified in both cases. Nineteen AS ‐1 RBC units manufactured from whole blood donations using a hard spin had a mean (±1 SD ) residual plasma content of 38 ± 8 mL , and 26 AS ‐3 RBC units manufactured using a soft spin had 66 ± 13 mL (p < 0.01). Conclusion RBC s continue to be manufactured from female donors of unknown or even known anti‐ HLA status. The residual plasma content of these RBC s may approach 100 mL . A combination of a high‐strength antibody and large residual plasma volume could explain severe or even fatal RBC ‐associated TRALI .