Peters Anna L, Van Stein Danielle, Vlaar Alexander P J
Laboratory of Experimental Intensive Care and Anaesthesia/Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands.
Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands.
Br J Haematol. 2015 Sep;170(5):597-614. doi: 10.1111/bjh.13459. Epub 2015 Apr 28.
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.
输血相关急性肺损伤（TRALI）是一种由输血引起的呼吸窘迫综合征，是输血相关死亡的主要原因。大多数TRALI病例与供体血液中人类白细胞抗原（HLA）和人类中性粒细胞抗原（HNA）抗体的被动输注有关。体外、离体和体内动物模型为TRALI的发病机制提供了见解。与TRALI相关的各类抗体似乎具有不同的病理生理机制来诱导TRALI，涉及内皮细胞、中性粒细胞、单核细胞，以及最近发现的淋巴细胞。HLA和HNA抗体主要存在于经产妇的血液中，因为她们在怀孕期间已被致敏。采用仅男性献血策略后，TRALI的发病率迅速下降。本综述重点关注研究抗体介导的TRALI病理生理学的临床前和临床研究。
