Two cases of transfusion-related acute lung injury triggered by HLA and anti-HLA antibody reaction.
Transfusion-related acute lung injury (TRALI) is a serious adverse transfusion reaction that is presented as acute hypoxemia and non-cardiogenic pulmonary edema, which develops during or within 6 hr of transfusion. Major pathogenesis of TRALI is known to be related with anti-HLA class I, anti-HLA class II, or anti-HNA in donor's plasma. However, anti-HLA or anti-HNA in recipient against transfused donor's leukocyte antigens also cause TRALI in minor pathogenesis and which comprises about 10% of TRALI. Published reports of TRALI are relatively rare in Korea. In our cases, both patients presented with dyspnea and hypoxemia during transfusion of packed red blood cells and showed findings of bilateral pulmonary infiltrations at chest radiography. Findings of patients' anti-HLA antibodies and recipients' HLA concordance indicate that minor pathogenesis may be not as infrequent as we'd expected before. In addition, second case showed that anti-HLA class II antibodies could be responsible for immunopathogenic mechanisms, alone.
Lee
Ji Hyun
JH
Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Kang
Eun-Suk
ES
Kim
Dae-Won
DW
D055371:Acute Lung Injury / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000276:immunology*; D000368:Aged; D000937:Antigen-Antibody Reactions; D004417:Dyspnea / Q000175:diagnosis; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D015395:Histocompatibility Antigens Class I / Q000276:immunology; D000949:Histocompatibility Antigens Class II / Q000276:immunology; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis; D007518:Isoantibodies / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D065227:Transfusion Reaction
D006680:HLA Antigens; D015395:Histocompatibility Antigens Class I; D000949:Histocompatibility Antigens Class II; D007518:Isoantibodies
Hematology. 2007 Oct;12(5):461-9
17852461
Am Rev Respir Dis. 1983 Jul;128(1):185-9
6603182
Transfusion. 2008 Nov;48(11):2401-8
18673344
Br J Haematol. 1996 Jun;93(3):707-13
8652399
Blood. 2008 May 15;111(10):5257-8
18467613
Transfusion. 2009 Jan;49(1):13-20
18954397
Transfus Apher Sci. 2007 Dec;37(3):273-82
18036987
Transfusion. 2007 Jan;47(1):171-2
17207246
Transfusion. 2008 Oct;48(10):2167-76
18564387
Am J Clin Pathol. 2008 Feb;129(2):287-97
18208810
Transfus Med. 2007 Apr;17(2):129-34
17430469
Br J Haematol. 2002 Mar;116(3):673-6
11849232
Transfusion. 2003 Feb;43(2):177-84
12559013
Transfusion. 2004 Dec;44(12):1774-89
15584994
Transfus Med. 2008 Oct;18(5):276-80
18937733
Transfusion. 2007 Jul;47(7):1118-24
17581145
Crit Care Med. 2006 May;34(5 Suppl):S118-23
16617255
Transfusion. 2007 Apr;47(4):559-62
17381610