#24
A FATAL TRANSFUSION RELATED ACUTE LUNG INJURY (TRALI) DUE TO HLA ANTIBODIES NOT DETECTED BY COMPLEMENT DEPENDENT CYTOTOXICITY (CDC) ASSAYS.
Z. MehdizadehKashi 1, M. Jensen 1, A. Karsk 1, J. Alcorn 1 and S. Pendergrass 1. 1 HLA Lab, American Red Cross, Portland, OR .
A 72-year old male with diagnosis of GI bleed on Coumadin received two units of frozen plasma following admission to ICU. During the second unit transfusion, he developed respiratory compromise and severe hypotension and was placed on aggressive respiratory support. The patient
s clinical condition deteriorated and he expired 5 hours after initial transfusion. Chest X-Ray showed a noncardiogenic pulmonary edema pattern. TRALI was suspected as the initial investigation showed no evidence of hemolytic reaction or bacterial contamination. Review of the involved donors showed that both were repeat multiparous donors. TRALI workup was initiated. Patient and donors granulocyte antibody tests were negative. HLA Class I antibody results were negative using standard CDC and ELISA. These tests were confirmed negative by an outside facility. All sera tested negative using AHG augmented-cytotoxicity technique. Flow PRA was run on samples. Patients pre and post sera was negative. One of the donors had 85% positive PRA for Class II antibodies but no Class I antibodies were detected. The second donor had 83% anti-Class I antibodies, and 62% anti-Class II antibodies. Laboratory investigation could not rule out either of the involved donors due to the inability to determine specificity of HLA antibodies present. Therefore, both donors were considered implicated and deferred indefinitely. The laboratory findings supported the diagnosis of TRALI and other causes of pulmonary edema were excluded by a combination of lab tests, imaging studies and post-mortem exam.TRALI is the number one cause of transfusion related mortality. This case demonstrates the importance of follow-up testing on donors implicated in a TRALI reaction.