title: Transfusion-related acute lung injury reports in the Netherlands: an observational study.
abstract: BACKGROUND
  Transfusion-related acute lung injury (TRALI) is a serious, sometimes fatal complication of transfusion, attributed to white blood cell (WBC)-reactive antibodies present in the blood product. This study investigated incidence and etiology in the Netherlands.
  
  
  METHODS
  From January 2005 through July 2007, all TRALI cases reported to the Sanquin Blood Banks were evaluated. Only cases meeting the Canadian Consensus Conference criteria for TRALI were included and investigated for patient, donor, and product characteristics. Patients and donors were screened for HLA Class I, HLA Class II, and granulocyte antibodies.
  
  
  RESULTS
  A total of 56 TRALI cases were reported of which 49 were completely evaluated. Seventy-eight percent of the patients needed monitoring or mechanical ventilation on the intensive care unit, 10 patients died. In 61% of cases large-volume plasma products were involved. WBC-reactive antibodies in donors were found in 73% of cases, with proven incompatibility in 21 of 44 (48%) investigated cases. Possible TRALI cases, as defined by the Canadian Consensus Conference, had significantly lower incompatibility rates compared to TRALI cases, 18% versus 58% (p = 0.036). In the 21 alloimmune cases, a total of 31 implicated donors were found, of which 26 were female, including 12 fresh-frozen plasma (FFP) products.
  
  
  CONCLUSIONS
  TRALI is the most serious transfusion complication in the Netherlands, causing severe morbidity and mortality. Antibodies were found in the majority of the cases, but causality with proven incompatibility could be established in 21 cases (48%). Female FFP products were involved in 57% of proven alloimmune cases and would theoretically be prevented using male FFP only.
authors.affiliation: Sanquin Blood Bank South West Region, Rotterdam, The Netherlands.
authors.forename: Daniëlle
authors.initials: D
authors.lastname: van Stein
authors.forename: Erik A
authors.initials: EA
authors.lastname: Beckers
authors.forename: Kees
authors.initials: K
authors.lastname: Sintnicolaas
authors.forename: Leendert
authors.initials: L
authors.lastname: Porcelijn
authors.forename: Fikreta
authors.initials: F
authors.lastname: Danovic
authors.forename: Jacques A
authors.initials: JA
authors.lastname: Wollersheim
authors.forename: Anneke
authors.initials: A
authors.lastname: Brand
authors.forename: Dick J
authors.initials: DJ
authors.lastname: van Rhenen
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology* / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001787:Blood Group Incompatibility / Q000276:immunology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007518:Isoantibodies / Q000097:blood; D007962:Leukocytes / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009426:Netherlands / Q000453:epidemiology; D010949:Plasma; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D007518:Isoantibodies