Department of Pathology, University of Alabama at Birmingham, AL, USA.
Am J Clin Pathol. 2012 Oct;138(4):498-503. doi: 10.1309/AJCPFF6JKXM7BYOI.
Transfusion-related acute lung injury (TRALI) is a serious condition characterized by respiratory distress, hypoxia, and bilateral pulmonary infiltrates, which occur within 6 hours of transfusion. Several theories have been proposed to explain the underlying pathologic mechanisms of TRALI. Immune-mediated TRALI accounts for over 80% of reported cases and is mediated by donor antibodies to HLAs and/or human neutrophil antigens (HNA). Immune-mediated TRALI is most commonly associated with donor plasma transfusion or other blood products from multiparous women, which has led many countries to reduce or exclude women from donating high-volume plasma products. This policy change has resulted in a decrease in the incidence of TRALI and highlighted the importance of nonimmune-mediated TRALI, which is thought to be caused by bioreactive lipids and other biologic response modifiers that accumulate during storage of blood products. When TRALI is suspected, clinical consultation with a transfusion medicine specialist helps differentiate it from other transfusion reactions with similar characteristics.
输血相关急性肺损伤（TRALI）是一种严重的疾病，其特征是在输血后 6 小时内出现呼吸窘迫、缺氧和双侧肺部浸润。已经提出了几种理论来解释 TRALI 的潜在病理机制。免疫介导的 TRALI 占报告病例的 80%以上，由针对 HLA 和/或人类中性粒细胞抗原（HNA）的供体抗体介导。免疫介导的 TRALI 最常与供体血浆输血或其他来自多产妇的血液制品有关，这导致许多国家减少或排除妇女捐献大容量血浆制品。这一政策变化导致 TRALI 的发病率下降，并强调了非免疫介导的 TRALI 的重要性，据认为这种 TRALI 是由生物反应性脂质和其他在血液制品储存过程中积累的生物反应调节剂引起的。当怀疑发生 TRALI 时，与输血医学专家进行临床咨询有助于将其与具有相似特征的其他输血反应区分开来。
