#18
COMPLEMENT ACTIVATION ASSOCIATED WITH TRANSFUSION RELATED ACUTE LUNG INJURY (TRALI).
D. Ambruso 1,2, P. Giclas 3, C. Silliman 1,2, M. Kelher 1,2, J. Niedzinski 4 and S. Geier 4. 1 Bonfils Blood Center ; 2 University of Colorado School of Medicine ; 3 National Jewish Medical & Research Center and 4 Laboratories At Bonfils, Denver, CO, USA .
TRALI is acute lung injury occurring during or within hours of a blood transfusion. Causes may be infusion of HLA antibodies and neutrophil priming and activation by lipids. We report a TRALI reaction by fresh frozen plasma (FFP) and activation of complement in the FFP and the patient. A 59 year old male was given 3 units of FFP from 3 donors. During infusion of the third unit, he developed dyspnea and cyanosis requiring ventilator. A chest x-ray showed bilateral diffuse pulmonary infiltrates.
Donors and units were screened for the presence of HLA antibodies by FLOW and ELISA PRA. The third unit had a PRA of class I=36%, II=91%. The Flow crossmatch was positive on recipient B, indicating reactivity of donor FFP IgG against recipient DR11, 13.
Priming activity of the implicated FFP, fresh plasma from donor and recipient, and plasma from controls was tested against freshly isolated neutrophils from the three sources. The FFP unit primed the fMLP response in donor, recipient and control neutrophils 2.6, 3.1, and 3.4 fold above baseline. Testing of donor, recipient and control plasma obtained 3 months after the reaction showed no priming. Surprisingly, evidence of complement activation was seen in the FFP unit: C4aLE 214%, C3aLE 402%,
C5b-9 213% of normal, but not in subsequent samples from the donor.
FFP with activated complement which primed neutrophils may have induced TRALI distinct from any subsequent effect of antibodies. Although the cause of FFP complement activation is not defined, these results suggest that actiated complement may be responsible for or contribute to HLA antibody-associated TRALI.