The effect of previous pregnancy and transfusion on HLA alloimmunization in blood donors: implications for a transfusion-related acute lung injury risk reduction strategy.
BACKGROUND
Antibodies to human leukocyte antigens (HLA) in donated blood have been implicated as a cause of transfusion-related acute lung injury (TRALI). A potential measure to reduce the risk of TRALI includes screening plateletpheresis donors for HLA antibodies. The prevalence of HLA antibodies and their relationship to previous transfusion or pregnancy in blood donors was determined.


METHODS
A total of 8171 volunteer blood donors were prospectively recruited by six US blood centers from December 2006 to May 2007. Donors provided a detailed history of pregnancy and transfusion and a sample for HLA Class I and II antibody testing by multiantigen bead flow analysis.


RESULTS
A total of 8171 donors were enrolled; 7920 (96.9%) had valid HLA antibody test results and 7841 (99%) of those had complete pregnancy and transfusion information. The prevalence of any HLA antibody was similar in nontransfused (n = 1138) and transfused (n = 895) men, 1.0% versus 1.7% (p = 0.16). HLA antibodies were detected in 17.3% of all female donors (n = 5834) and in 24.4% of those with a history of previous pregnancy (n = 3992). The prevalence of HLA antibodies increased in women with greater numbers of pregnancy: 1.7% (zero), 11.2% (one), 22.5% (two), 27.5% (three), and 32.2% (four or more pregnancies; p < 0.0001).


CONCLUSIONS
HLA Class I and Class II antibodies are detectable at low prevalence in male donors regardless of transfusion and in female donors without known immunizing events. The prevalence of HLA antibodies increases significantly with more pregnancies. These data will allow blood centers to estimate the impact of HLA antibody testing as a potential TRALI risk reduction measure.
Triulzi
Darrell J
DJ
From the Institute for Transfusion Medicine, Pittsburgh, Pennsylvania, USA.
Kleinman
Steven
S
Kakaiya
Ram M
RM
Busch
Michael P
MP
Norris
Philip J
PJ
Steele
Whitney R
WR
Glynn
Simone A
SA
Hillyer
Christopher D
CD
Carey
Patricia
P
Gottschall
Jerome L
JL
Murphy
Edward L
EL
Rios
Jorge A
JA
Ness
Paul M
PM
Wright
David J
DJ
Carrick
Danielle
D
Schreiber
George B
GB
D055371:Acute Lung Injury / Q000209:etiology* / Q000276:immunology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood / Q000276:immunology*; D001782:Blood Donors / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D012737:Sex Factors; D065227:Transfusion Reaction; D055815:Young Adult
D000906:Antibodies; D006680:HLA Antigens