Transfusion-related acute lung injury associated with interdonor incompatibility for the neutrophil-specific antigen HNA-1a.
OBJECTIVE
A patient transfused with two pooled platelet concentrates became breathless. Bilateral infiltrates were seen on chest X-ray. A diagnosis of transfusion-related acute lung injury (TRALI) was made. The patient received 100% oxygen and recovered after 5 days.


METHODS
Antibody screening, cross-matching for granulocyte and lymphocyte antibodies and typing for granulocyte antigens was undertaken.


RESULTS
The patient typed as HNA-1b/HNA-1b. Granulocyte and lymphocyte antibodies were not detected in the patient's serum or in any of the donor sera by cross-match. In antibody screening against typed panel granulocytes, complement-fixing anti-HNA-1a IgM antibodies were detected in the serum of one female donor. Two of the other donors who contributed to the pooled platelet concentrate containing the HNA-1a IgM antibodies typed as HNA-1a/HNA-1b.


CONCLUSIONS
Anti-HNA-1a IgM antibodies may have formed immune complexes with white cell fragments or soluble FcgammaRIII from HNA-1a+ donors in the pooled platelet concentrate and initiated TRALI.
Lucas
G
G
International Blood Group Reference Laboratory, Bristol, UK. geoff.lucas@nbs.nhs.uk
Rogers
S
S
Evans
R
R
Hambley
H
H
Win
N
N
D000328:Adult; D000936:Antigen-Antibody Complex / Q000009:adverse effects; D001782:Blood Donors; D001787:Blood Group Incompatibility / Q000150:complications*; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000009:adverse effects; D007518:Isoantibodies / Q000009:adverse effects; D007519:Isoantigens / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000209:etiology*
D000936:Antigen-Antibody Complex; D007075:Immunoglobulin M; D007518:Isoantibodies; D007519:Isoantigens; C067704:neutrophil-specific antigen NA1, human