title: Implementation and outcomes of a transfusion-related acute lung injury surveillance programme and study of HLA/HNA alloimmunisation in blood donors.
abstract: BACKGROUND
  Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-associated mortality. Antibodies against human leucocyte antigens (HLA) and human neutrophil antigens (HNA) are often detected in the implicated donors. We investigated the incidence and aetiology of TRALI in Lombardy. Moreover, we determined the rate of HLA and HNA alloimmunisation and the HNA genotype in a cohort of local blood donors.
  
  
  METHODS
  During a 2-year observational study in eight blood transfusion services, suspected TRALI cases were collected and characterised by means of HLA and HNA antibody screening of implicated donors, donor/recipient cross-matching and HLA/HNA molecular typing. In addition, 406 Italian donors were evaluated for alloimmunisation and in 102 of them HNA gene frequencies were determined.
  
  
  RESULTS
  Eleven cases were referred to the central laboratory, of whom three were diagnosed as having TRALI, seven as having possible TRALI and one as having transfusion-associated circulatory overload. Seven TRALI cases were immune-mediated whereas in three we did not find either alloantibodies in implicated donors or a positive reaction in the cross-match. The most frequently implicated blood component was red blood cells (in 5 males and in 1 female), whereas four cases of TRALI were associated with transfusion of fresh-frozen plasma (in 3 females and in 1 male). The frequency of reported TRALI/possible TRALI cases was 1:82,000 for red blood cells and 1:22,500 for fresh-frozen plasma. No cases were observed for platelets. Overall, the frequency of HLA or HNA alloimmunisation in blood donors was 29% for females and 7% for males. The latter could be related, at least in part, to natural antibodies. HNA gene frequencies showed that HNA-1b is more frequent than HNA-1a in our sample of donors.
  
  
  CONCLUSIONS
  The recently adopted national policy to prevent TRALI, i.e. using only plasma donated by males, would have had a positive impact in our setting.
authors.affiliation: Department of Regenerative Medicine, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milan, Italy. l.porretti@policlinico.mi.it
authors.forename: Laura
authors.initials: L
authors.lastname: Porretti
authors.forename: Alessandra
authors.initials: A
authors.lastname: Cattaneo
authors.forename: Elena
authors.initials: E
authors.lastname: Coluccio
authors.forename: Elena
authors.initials: E
authors.lastname: Mantione
authors.forename: Federico
authors.initials: F
authors.lastname: Colombo
authors.forename: Mariagabriella
authors.initials: M
authors.lastname: Mariani
authors.forename: Georgia
authors.initials: G
authors.lastname: Bottelli
authors.forename: Silvia
authors.initials: S
authors.lastname: Mazzucchelli
authors.forename: Marco
authors.initials: M
authors.lastname: Pappalettera
authors.forename: Tiziana
authors.initials: T
authors.lastname: Speranza
authors.forename: Maurizio
authors.initials: M
authors.lastname: Migliari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cambié
authors.forename: Daniele
authors.initials: D
authors.lastname: Prati
authors.forename: Paolo
authors.initials: P
authors.lastname: Rebulla
mesh_terms: D055371:Acute Lung Injury / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000276:immunology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016913:Blood Component Transfusion / Q000009:adverse effects*; D001782:Blood Donors; D002648:Child; D005260:Female; D006680:HLA Antigens / Q000097:blood / Q000276:immunology*; D006801:Humans; D007518:Isoantibodies / Q000097:blood / Q000276:immunology; D007519:Isoantigens / Q000097:blood / Q000276:immunology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000276:immunology* / Q000378:metabolism; D012189:Retrospective Studies; D012737:Sex Factors
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies; D007519:Isoantigens; C067704:neutrophil-specific antigen NA1, human