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TRANSFUSION RELATED ACUTE LUNG INSJURY (TRALI) CAUSED BY A REMOTE PREGNANCY- INDUCED CLASS II ANTIBODY.
Marilyn S. Pollack, PhD, John G. Buck, MD, Laura M. McNeish, BS and Chantal R. Harrison, MD. San Antonio TX, USA, University of Texas Health Science Center, 78229, Dept. of Pathology; Lackland AFB TX, USA, Wilford Hall Medical Center, 78236, Blood Services and San Antonio TX, USA, University Health System, 78229, Histocompatibility and Immunogenetics Laboratory.

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We recently investigated an apparent case of transfusion related acute lung injury (TRALI) in a 58 year old man who had received 4 units of plasma during treatment for a left foot abscess. His respiratory symptoms and fever were consistent with the diagnosis of TRALI although he did not have typical chest x-ray findings. Samples from each of the 4 units (2 from male and 2 from female donors) were tested for class I HLA antibodies. Three of the samples were negative; one of the female samples had antibodies to HLA-B39, but the patient lacked that specificity and class I flow crossmatch tests were negative. We subsequently heard that class II antibodies can also cause TRALI. All 4 plasma samples were screened using flow PRA Class II antigen coated beads and the other female donor was found to have high titers of antibodies to DR1, DR10, DR15 and DR16. The patient had both DR1 and DR15. This plasma donor and her husband were HLA typed and the husband was found to be mismatched for DR1 and was B-cell crossmatch positive. Surprisingly, the plasma donor had a history of only 2 pregnancies more than 15 years earlier and had never had any transfusions. Her antibody was not only specific for the immunizing antigen, DR1, but also reacted with other DR antigens known to share epitopes with DR1. When the risks for development of TRALI are better understood, multiparous transfusion donors should be screened for both Class I and Class II HLA antibodies before they are used for patients at risk.