Silliman C C, Paterson A J, Dickey W O, Stroneck D F, Popovsky M A, Caldwell S A, Ambruso D R
Bonfils Blood Center, Department of Pediatrics, University of Colorado School of Medicine, Denver, USA.
Transfusion. 1997 Jul;37(7):719-26. doi: 10.1046/j.1537-2995.1997.37797369448.x.
Transfusion-related acute lung injury (TRALI) is clinically similar to the adult respiratory distress syndrome (ARDS) and has been linked to the transfusion of leukocyte antibodies in blood components. Animal model have implicated neutrophil (PMN)-priming agents in ARDS; however, two agents were required. Previous studies showed the generation of PMN-priming agents during blood storage. Thus the association of PMN-priming agents with TRALI was examined.
Ten patients with TRALI and 10 with febrile or urticarial reactions (control group) were evaluated. The presence of PMN-priming activity was tested in the patients' pretransfusion and posttransfusion blood samples by incubating PMNs with these samples followed by activation of the respiratory burst. Plasma lipids were separated by normal-phase high-performance liquid chromatography (HPLC), and the priming activity was evaluated. The presence of leukocyte antibodies was determined in the blood donors and patients with TRALI.
Significantly more PMN-priming activity was present in the posttransfusion sera (11.4 +/- 1.8 nmol superoxide anion/min, mean +/- SEM; n = 10) and plasma of patients with TRALI than in their pretransfusion sera (6.5 +/- 1.5: n = 10) or in the pretransfusion and posttransfusion sera (5.1 +/- 1.3, n = 10; and 4.5 +/- 1.4, n = 10, respectively) and from the controls (p < 0.05). HPLC separation of lipids demonstrated that three active species were present in the posttransfusion plasma samples of TRALI patients. All the patients with TRALI had underlying clinical factors, such as infection, cytokine administration, recent surgery, or massive transfusion, while only 2 of 10 control patients had these clinical conditions. None of the donors had significant titers of HLA or HLA-DR antibodies; however, 50 percent had weak positivity for granulocyte antibodies.
TRALI is the result of two clinical events, the first being a predisposing clinical condition and the second being the transfusion of biologically active lipids in stored blood.
输血相关急性肺损伤（TRALI）在临床上与成人呼吸窘迫综合征（ARDS）相似，并且与血液成分中白细胞抗体的输血有关。动物模型表明中性粒细胞（PMN）启动剂与ARDS有关；然而，需要两种启动剂。先前的研究表明在血液储存期间会产生PMN启动剂。因此，研究了PMN启动剂与TRALI的关联。
评估了10例TRALI患者和10例发热或荨麻疹反应患者（对照组）。通过将PMN与这些样本孵育，然后激活呼吸爆发，在患者输血前和输血后的血液样本中测试PMN启动活性。通过正相高效液相色谱（HPLC）分离血浆脂质，并评估启动活性。在献血者和TRALI患者中测定白细胞抗体的存在。
TRALI患者输血后血清（11.4±1.8 nmol超氧阴离子/分钟，平均值±标准误；n = 10）和血浆中的PMN启动活性明显高于输血前血清（6.5±1.5；n = 10）或输血前和输血后血清（分别为5.1±1.3，n = 10；和4.5±1.4，n = 10）以及对照组（p <0.05）。脂质的HPLC分离表明，TRALI患者输血后血浆样本中存在三种活性物质。所有TRALI患者都有潜在的临床因素，如感染、细胞因子给药、近期手术或大量输血，而10例对照患者中只有2例有这些临床情况。没有一个献血者有显著滴度的HLA或HLA-DR抗体；然而，50%的献血者粒细胞抗体呈弱阳性。
TRALI是两个临床事件的结果，第一个是易感临床状况，第二个是储存血液中生物活性脂质的输血。
