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CRITICAL CARE AND TRAUMA

Severe Transfusion-Related Acute Lung Injury

Lukas Brander, MD^*, Angelika Reil, MD, Juergen Bux, MD, PhD, Behrouz Mansouri Taleghani, MD, Bruno Regli, MD^*, and Jukka Takala, MD, PhD^*

*Department of Intensive Care Medicine and Department of Hematology and Central Hematology Laboratory, Division of Transfusion Medicine, University Hospital-Inselspital, Bern, Switzerland; and Blood Transfusion Service, SRC Bern Ltd., Bern, Switzerland

Address correspondence to Lukas Brander, MD, Department of Intensive Care Medicine, University Hospital, Inselspital, 3010 Bern, Switzerland. Address e-mail to lukas.brander{at}insel.ch.

A 46-yr-old man developed severe hypoxemia, pulmonary infiltrates, and an acute decrease in his leukocyte count shortly after transfusion of fresh-frozen plasma (FFP) during recovery from cardiac surgery. Cardiogenic pulmonary edema was excluded. Granulocyte-reactive and agglutinating alloantibodies were detected in the serum of the fresh-frozen plasma donor. The cross-match with the patient’s granulocytes revealed antibodies specific for HLA class I. Transfusion-related acute lung injury (TRALI) is a potentially life-threatening, under-recognized and under-reported complication of transfusion. Conservative transfusion strategies and preclusion of the implicated blood donors with granulocyte-reactive antibodies from future blood donation may prevent TRALI and could save lives.

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