Moalic V, Vaillant C, Ferec C
Laboratoire HLA, service de génétique moléculaire et d'histocompatibilité, centre hospitalier universitaire Augustin-Morvan, 5 avenue Foch, 29200 Brest, France.
Pathol Biol (Paris). 2005 Mar;53(2):111-5. doi: 10.1016/j.patbio.2004.06.001.
Transfusion related acute lung injury (TRALI) is a rare but potentially severe complication of blood transfusion, manifested by pulmonary oedema, fever and hypotension. The signs and symptoms are often attributed to other clinical aspects of a patient's condition, and therefore, TRALI may go unrecognised. It has been estimated to be the third cause of transfusion related mortality, so it should be better diagnosed. Cases are related to multiple blood units, such as white blood cells, red blood cells, fresh frozen plasma, platelets or intravenous immunoglobulins. Physiopathology of TRALI is poorly understood, and still controversial. It is often due to an immunological conflict between transfused plasma antibodies and recipients' blood cells. These antibodies are either HLA (class I or II) or granulocyte-specific. They appear to act as mediators, which result in granulocytes aggregation, activation and micro vascular pulmonary injury. Lipids or cytokines in blood units are also involved as TRALI priming agents. Diagnosis is based on antibody screening in blood components and on specific-antigen detection in the recipient. The screening of anti-HLA or anti-granulocytes is recommended as part of prevention for female donors who had been pregnant. Preventative measures should also include leucoreduction and measures to decrease the amount of priming agents in blood components. In this article, we summarise what is known about TRALI, and we focus attention on unanswered questions and controversial issues related to TRALI.
输血相关急性肺损伤（TRALI）是一种罕见但可能严重的输血并发症，表现为肺水肿、发热和低血压。其体征和症状常被归因于患者病情的其他临床方面，因此，TRALI可能未被识别。据估计，它是输血相关死亡的第三大原因，所以应更好地进行诊断。病例与多种血液成分有关，如白细胞、红细胞、新鲜冰冻血浆、血小板或静脉注射免疫球蛋白。TRALI的病理生理学了解甚少，且仍存在争议。它通常是由于输入的血浆抗体与受血者血细胞之间的免疫冲突所致。这些抗体要么是HLA（I类或II类），要么是粒细胞特异性的。它们似乎起到介质的作用，导致粒细胞聚集、激活和肺微血管损伤。血液成分中的脂质或细胞因子也作为TRALI启动剂参与其中。诊断基于血液成分中的抗体筛查以及受血者中的特异性抗原检测。对于曾怀孕的女性献血者，建议进行抗HLA或抗粒细胞筛查作为预防措施的一部分。预防措施还应包括白细胞滤除以及减少血液成分中启动剂含量的措施。在本文中，我们总结了关于TRALI的已知情况，并关注与TRALI相关的未解决问题和有争议的问题。
