Canadian Blood Services, Toronto, Ontario, Canada.
Department of Pathology and Molecular Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Ontario, Canada.
Transfusion. 2021 Apr;61(4):1336-1340. doi: 10.1111/trf.16330. Epub 2021 Mar 5.
Transfusion-related acute lung injury (TRALI) is a transfusion complication often mediated by recipient exposure to plasma from donors with human leukocyte antigen (HLA) and human neutrophil antigen (HNA) antibodies. Recipient anti-donor HLA or HNA antibodies have rarely been implicated.
Herein, we describe a case of fatal TRALI mediated by recipient anti-HLA and anti-HNA antibodies. Cognate antibody-antigen match was confirmed with serologic and molecular assays.
A 69-year-old G5P5 female with no prior transfusion history and metastatic cholangiocarcinoma with thromboembolic complications presented with heart failure and dyspnea. She was transfused 15 ml of a unit of Fy -negative red blood cells and subsequently developed acute onset dyspnea, hypoxemia, hypotension, and fever. Clinical investigations revealed bilateral infiltrates on chest X-ray and cognate recipient HLA and HNA antibodies to donor antigens. The patient died of acute respiratory failure within 24 h of transfusion. In total, the patient had Fy , HLA Class I, HNA, and human platelet antigen (HPA) alloantibodies. The 63-year-old female donor had detectable HLA class II antibodies (recipient class II genotype unavailable).
The pathophysiology of TRALI has traditionally been ascribed to underlying conditions that put the recipient at risk in combination with donor biological response modifiers. This case illustrates alternative pathogenic mediators including alloantibodies to donor HLA and HNA. Additional studies to determine the contribution and frequency of recipient alloantibodies in TRALI may inform future mitigation strategies to further reduce the incidence of TRALI, particularly in female transfusion recipients.
输血相关性急性肺损伤（TRALI）是一种输血并发症，通常由受者暴露于具有人类白细胞抗原（HLA）和人类中性粒细胞抗原（HNA）抗体的供者血浆引起。受者针对供者 HLA 或 HNA 抗体的反应很少被涉及。
在此，我们描述了一例由受者针对 HLA 和 HNA 抗体引起的致命性 TRALI 病例。通过血清学和分子检测证实了同源抗体-抗原匹配。
一名 69 岁的 G5P5 女性，无既往输血史，患有转移性胆管癌伴血栓栓塞并发症，表现为心力衰竭和呼吸困难。她输注了 15 毫升 Fy-阴性红细胞单位，随后出现急性呼吸困难、低氧血症、低血压和发热。临床研究显示，胸部 X 线片双侧浸润，以及受者针对供者抗原的同源 HLA 和 HNA 抗体。患者在输血后 24 小时内死于急性呼吸衰竭。该患者总共存在 Fy、HLA Ⅰ类、HNA 和人类血小板抗原（HPA）同种抗体。63 岁的女性供者存在可检测的 HLA Ⅱ类抗体（受者Ⅱ类基因型不可用）。
TRALI 的病理生理学传统上归因于使受者处于风险中的潜在疾病，以及供者生物反应调节剂。该病例说明了替代的致病介质，包括针对供者 HLA 和 HNA 的同种抗体。进一步确定 TRALI 中受者同种抗体的贡献和频率的研究可能为进一步减少 TRALI 的发生率提供信息，特别是在女性输血受者中。
