TRALI: correlation of antigen-antibody and monocyte activation in donor-recipient pairs.
BACKGROUND
TRALI may be a severe reaction associated with transfusion of plasma-containing blood components. TRALI has usually been associated with antibodies against granulocytes and HLA class I antigens, but more recently with antibodies against HLA class II and monocytes. TRALI cases were investigated to determine correlation between antigen and antibody. Additionally, activation of monocytes by TRALI serums was studied.


METHODS
Sixteen cases of TRALI were investigated. All patients were typed for HLA antigens. Implicated donors were screened for HLA antigens and antibodies against granulocytes and monocytes. In 6 cases, recipient monocyte activation was measured in vitro after incubation with TRALI and control serums. In four cases, monocyte activation was measured after incubation of TRALI serums against a panel of monocytes of known HLA antigen type.


RESULTS
In 14 of the 16 cases (87.5%), antigen-antibody correlation was identified. TRALI monocytes, incubated with implicated TRALI serum (n = 6), expressed significantly greater cytokine and tissue factor (p < 0.05, repeated-measures ANOVA) than controls. Panel monocytes incubated with TRALI serum showed increased expression of cytokine and/or tissue factor when corresponding antigen was present.


CONCLUSIONS
In most cases of TRALI, a correlation between antigen and antibody can be identified. Activation of monocytes and their subsequent release of cytokines may play a role in the pathogenesis of TRALI.
Kopko
Patricia M
PM
BloodSource (Sacramento Medical Foundation Blood Centers), Sacramento, California, USA. patricia.kopko@bloodsource.org
Paglieroni
Teresa G
TG
Popovsky
Mark A
MA
Muto
Kathryn N
KN
MacKenzie
Malcolm R
MR
Holland
Paul V
PV
D001782:Blood Donors; D016207:Cytokines / Q000096:biosynthesis; D005260:Female; D006098:Granulocytes / Q000276:immunology; D015395:Histocompatibility Antigens Class I / Q000032:analysis / Q000276:immunology; D000949:Histocompatibility Antigens Class II / Q000032:analysis / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000097:blood / Q000276:immunology; D007519:Isoantigens / Q000097:blood / Q000276:immunology; D008297:Male; D009000:Monocytes / Q000276:immunology* / Q000378:metabolism; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000209:etiology / Q000276:immunology*; D013925:Thromboplastin / Q000096:biosynthesis; D065227:Transfusion Reaction
D016207:Cytokines; D015395:Histocompatibility Antigens Class I; D000949:Histocompatibility Antigens Class II; D007518:Isoantibodies; D007519:Isoantigens; D013925:Thromboplastin