title: Ten years of hemovigilance reports of transfusion-related acute lung injury in the United Kingdom and the impact of preferential use of male donor plasma.
abstract: METHODS
  From 1996 through 2006, 195 cases were reported as transfusion-related acute lung injury (TRALI) to the Serious Hazards of Transfusion scheme and from 1999 onward classified by probability, using clinical features and HLA and/or HNA typing. From late 2003, the National Blood Service provided 80 to 90 percent of fresh-frozen plasma (FFP) and plasma for platelet (PLT) pools from male donors.
  
  
  RESULTS
  Forty-nine percent of reports were highly likely/probable TRALI, and 51 percent possible/unlikely. Of 96 investigations, donor antibodies recognizing recipient antigens were found in 73 cases (65%), with HLA Class I in 25 of those (40%), HLA Class II antibodies in 38 (62%), and granulocyte antibodies in 12 (17%). A review in 2003 revealed that the TRALI risk/component was 6.9 times higher for FFP and 8.2 times higher for PLTs than for red blood cells, and that in donors of implicated FFP/PLTs, white blood cell antibodies were found 3.6 times more often than by chance (p <or= 0.0001), with all implicated donors being female. Provision of male plasma was associated with a reduction in TRALI reports from 36 in 2003 to 23 in each of 2004 and 2005 and 10 in 2006. Highly likely/probable cases reduced from 22 in 2003 to 13, 6, and 3 [corrected] in the 3 subsequent years, with cases implicating FFP or PLTs with positive donor serology [corrected] falling from 16 to 9, 3, and 1 respectively.
  
  
  CONCLUSIONS
  The risk of highly likely/probable TRALI due to FFP has fallen from 15.5 per million units issued during 1999 through 2004 to 3.2 per million during 2005 through 2006 (p = 0.0079) and from 14.0 per million to 5.8 per million for PLTs.
authors.affiliation: NHS Blood and Transplant, Newcastle Upon Tyne, UK. catherine.chapman@nhsbt.nhs.uk
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Chapman
authors.forename: Dorothy
authors.initials: D
authors.lastname: Stainsby
authors.forename: Hilary
authors.initials: H
authors.lastname: Jones
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Love
authors.forename: Edwin
authors.initials: E
authors.lastname: Massey
authors.forename: Nay
authors.initials: N
authors.lastname: Win
authors.forename: Cristina
authors.initials: C
authors.lastname: Navarrete
authors.forename: Geoff
authors.initials: G
authors.lastname: Lucas
authors.forename: Neil
authors.initials: N
authors.lastname: Soni
authors.forename: Cliff
authors.initials: C
authors.lastname: Morgan
authors.forename: Louise
authors.initials: L
authors.lastname: Choo
authors.forename: Hannah
authors.initials: H
authors.lastname: Cohen
authors.forename: Lorna M
authors.initials: LM
authors.lastname: Williamson
mesh_terms: D055371:Acute Lung Injury / Q000453:epidemiology*; D001782:Blood Donors; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D010949:Plasma; D012737:Sex Factors; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome