Antibody-mediated transfusion-related acute lung injury; from discovery to prevention.
Transfusion-related acute lung injury (TRALI), a syndrome of respiratory distress caused by blood transfusion, is the leading cause of transfusion-related mortality. The majority of TRALI cases have been related to passive infusion of human leucocyte antigen (HLA) and human neutrophil antigen (HNA) antibodies in donor blood. In vitro, ex vivo and in vivo animal models have provided insight in TRALI pathogenesis. The various classes of antibodies implicated in TRALI appear to have different pathophysiological mechanisms for the induction of TRALI involving endothelial cells, neutrophils, monocytes and, as very recently has been discovered, lymphocytes. The HLA and HNA-antibodies are found mainly in blood from multiparous women as they have become sensitized during pregnancy. The incidence of TRALI has decreased rapidly following the introduction of a male-only strategy for plasma donation. This review focuses on pre-clinical and clinical studies investigating the pathophysiology of antibody-mediated TRALI.
Laboratory of Experimental Intensive Care and Anaesthesia/Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands.
Anna L
AL
Peters
Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands.
Danielle
D
Van Stein
Laboratory of Experimental Intensive Care and Anaesthesia/Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands.
Alexander P J
AP
Vlaar
D055371:Acute Lung Injury / Q000453:epidemiology / Q000209:etiology / Q000276:immunology; D001803:Blood Transfusion; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D015994:Incidence; D007518:Isoantibodies / Q000276:immunology*; D008297:Male; D011247:Pregnancy
D006680:HLA Antigens; D007518:Isoantibodies
human leucocyte antigens; human neutrophil antigens; pathophysiology; transfusion; transfusion-related acute lung injury