Relationship of donor HLA antibody strength to the development of transfusion-related acute lung injury.
BACKGROUND
Antibodies against the human leukocyte antigen (HLA) in donors' blood are implicated in the development of transfusion-related acute lung injury (TRALI). Screening of female donors for HLA antibodies has been introduced to prevent TRALI; however, the relationship of HLA antibody strength in the transfused components to the development of TRALI has not been evaluated in detail.


METHODS
Donors involved in 1038 cases of nonhemolytic transfusion reactions (NHTRs) including 283 cases of TRALI were screened for HLA antibodies by the fluorescence beads method. HLA antibody specificity and strength were analyzed in detail. The usefulness of enzyme-linked immunosorbent assay (ELISA) for screening HLA antibodies was also evaluated.


RESULTS
Among 21 cases of TRALI, four cases of possible TRALI, and five cases of other NHTRs, the sum of mean fluorescence intensity (MFI) of donors' HLA antibodies to patients' cognate antigen(s) was determined in 18, four, and three cases, respectively. The sum of MFI in TRALI cases was significantly higher than that in other NHTR cases (p<0.05). When HLA antibody-positive samples were reevaluated by ELISA, the ELISA optical density ratio was significantly higher in donors' samples associated with TRALI than in those associated with other NHTRs (p<0.01)


CONCLUSIONS
A correlation between the HLA antibody strength and development of TRALI was indicated. The antibody strength measured by ELISA could be used as the basis for the screening of HLA antibodies in place of the fluorescence beads method. This study provided clues to the establishment of a cutoff value for HLA antibody screening in an evidence-based manner for the prevention of TRALI.
Hashimoto
Shiho
S
Research and Development Department, Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan.
Nakajima
Fumiaki
F
Kamada
Hiromi
H
Kawamura
Kumiko
K
Satake
Masahiro
M
Tadokoro
Kenji
K
Okazaki
Hitoshi
H
D055371:Acute Lung Injury / Q000097:blood / Q000209:etiology* / Q000276:immunology*; D000328:Adult; D000368:Aged; D000465:Algorithms; D000915:Antibody Affinity / Q000502:physiology*; D000918:Antibody Specificity / Q000502:physiology; D001782:Blood Donors; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D015395:Histocompatibility Antigens Class I / Q000276:immunology; D000949:Histocompatibility Antigens Class II / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000032:analysis / Q000276:immunology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D012698:Serologic Tests; D065227:Transfusion Reaction; D014181:Transplantation Immunology / Q000502:physiology
D006680:HLA Antigens; D015395:Histocompatibility Antigens Class I; D000949:Histocompatibility Antigens Class II; D007518:Isoantibodies