title: Underdiagnosing of antibody-mediated transfusion-related acute lung injury: evaluation of cellular-based versus bead-based techniques.
abstract: OBJECTIVE
  Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. To support the diagnosis of antibody-mediated TRALI, HLA and HNA antibodies are tested in involved blood donors. Identification of antibody positive donors is important as exclusion of these donors is part of preventative strategies against TRALI. We compared cellular-based versus bead-based techniques for diagnosis of antibody-mediated TRALI.
  
  
  METHODS
  All reported TRALI cases in the Netherlands during a 5-year period were evaluated. Donors were screened for the presence of HLA class I and class II antibodies using both cellular-based and bead-based techniques.
  
  
  RESULTS
  In total, 100 TRALI cases were reported of which 91 were fully tested. In 113 donors, HLA antibodies were detected of which 84 were only detected by bead-based techniques, 12 only by cellular-based tests and 17 by both assays. Antibody-mediated TRALI was diagnosed in 44 of 91 reported cases. Twenty-one (48%) of these cases would not have been identified using only cellular-based assays.
  
  
  CONCLUSIONS
  Bead-based techniques show a higher sensitivity for detecting incompatible donors in TRALI cases than cellular-based assays. These results suggest that the use of bead-based assays will result in a significant reduction of future TRALI reactions as more antibody positive donors will be excluded from future donations.
authors.affiliation: Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: van Stein
authors.affiliation: Department of Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: E A M
authors.initials: EA
authors.lastname: Beckers
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: A L
authors.initials: AL
authors.lastname: Peters
authors.affiliation: Sanquin Diagnostics, Sanquin Blood Bank, Amsterdam, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Porcelijn
authors.affiliation: Center for clinical transfusion research, Sanquin Research, Leiden, The Netherlands.|Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: R A
authors.identifier: http://orcid.org/0000-0002-6545-7277
authors.initials: RA
authors.lastname: Middelburg
authors.affiliation: Sanquin Diagnostics, Sanquin Blood Bank, Amsterdam, The Netherlands.
authors.forename: N M
authors.initials: NM
authors.lastname: Lardy
authors.affiliation: South West Region, Sanquin Blood Bank, Rotterdam, The Netherlands.
authors.forename: D J
authors.initials: DJ
authors.lastname: van Rhenen
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: A P J
authors.initials: AP
authors.lastname: Vlaar
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000974:Antibodies, Antinuclear / Q000097:blood / Q000276:immunology; D001782:Blood Donors; D002648:Child; D002675:Child, Preschool; D005260:Female; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007518:Isoantibodies / Q000097:blood / Q000276:immunology*; D008297:Male; D008856:Microscopy, Fluorescence; D008875:Middle Aged; D009426:Netherlands; D065227:Transfusion Reaction; D055815:Young Adult
chemical_list: D000974:Antibodies, Antinuclear; D006680:HLA Antigens; D007518:Isoantibodies
keywords: HLA antibodies; bead-based assays; cellular-based assays; diagnosis; transfusion-related acute lung injury