Plasma and lipids from stored platelets cause acute lung injury in an animal model.
BACKGROUND
Transfusion of PLT concentrates may cause TRALI, a life-threatening reaction that has been linked to the infusion of anti-WBC immunoglobulins or older, stored PLTs that contain bioactive lipids. We hypothesize that lipids generated during storage of PLTs cause TRALI in a two-event animal model.


METHODS
Plasma from both whole-blood PLTs (WB-PLTs) and apheresis PLTs (A-PLTs) was isolated on Day 0 (D.0) and Day 5 (D.5) of storage and heat-treated before use. Rats were pretreated with saline or 2 mg per kg endotoxin (LPS), anesthetized, and the lungs were ventilated, isolated, and perfused with saline or 5-percent PLT plasma. Pulmonary artery pressure, pulmonary edema, and leukotriene B4 levels (perfusate) were measured.


RESULTS
Plasma from D.5, but not D.0, of the identical WB-PLT and A-PLT units caused injury in lungs from LPS-pretreated rats (LPS/D.5) evidenced by increases in pulmonary edema and leukotriene B4 (p < 0.05). Lipid extracts and purified lipids from D.5 PLT plasma also elicited injury in lungs from LPS-pretreated rats (p < 0.05). Saline/D.5 plasma or lipids or LPS/D.0 did not cause pulmonary edema. Prestorage WBC reduction was ineffective in inhibiting TRALI.


CONCLUSIONS
PLT-induced TRALI may be the result of two events: 1) the clinical condition of the patient and 2) the infusion of lipids in stored PLTs.
Silliman
Christopher C
CC
Bonfils Blood Center, 717 Yosemite Circle, Denver, CO 80123, USA. christopher.silliman@uchsc.edu
Bjornsen
A Jason
AJ
Wyman
Travis H
TH
Kelher
Marguerite
M
Allard
Jenny
J
Bieber
Sarah
S
Voelkel
Norbert F
NF
D000208:Acute Disease; D000328:Adult; D000818:Animals; D001790:Blood Physiological Phenomena; D001792:Blood Platelets / Q000378:metabolism*; D001793:Blood Preservation; D001794:Blood Pressure; D006801:Humans; D066298:In Vitro Techniques; D007937:Leukapheresis; D007975:Leukotriene B4 / Q000032:analysis; D008055:Lipids / Q000502:physiology*; D008168:Lung / Q000378:metabolism; D008171:Lung Diseases / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D010477:Perfusion; D011651:Pulmonary Artery / Q000503:physiopathology; D011654:Pulmonary Edema / Q000209:etiology; D051381:Rats; D017207:Rats, Sprague-Dawley; D065227:Transfusion Reaction
D008055:Lipids; D007975:Leukotriene B4