Jump to content

TRALI


jojo808

Recommended Posts

Previous Quote from Malcom Needs while searching older content on this subject:  "In most cases, TRALI is caused by donor leucocyte antibodies reacting with alloantigens present on the patient's leucocytes, although patient alloantibodies have been involved in some rare cases. The antibodies concerned are usually HLA class I and II specific, but HNA antibodies have also caused this".  The thread was actually discussing solvent detergent plasma.

When investigating possible TRALI, exactly what tests are usually ordered on the implicated donor? (Antibodies against HLA class I and II? And what are HNA antibodies and what's the difference between HLA and HNA antibodies? Aren't they both testing for antibodies against white cells??

Also if donor is found to have HLA antibodies, does it matter to identify them and then test the recipient for the antigen??? I'm a little confused.

Link to comment
Share on other sites

While TRALI can be caused by both HLA class I and II antibodies (these antigens are present on most cells (class I) and antigen presenting cells (class II) and HNA (human neutrophil antigens present only on neutrophils in most cases), most respiratory distress after transfusions is caused by other mediators (lipids, CD40L and probably free hemoglobin and heme) and does not require any specific workup of the donor as antibodies are involved only in a few cases (we haven't seen one in years).  Some folks in the field do wish to perform antibody studies, but I think they are largely a waste of time, except for transfused or multiparous patients.  Others are extremely unlikely to have antibodies in the donor blood.  As evidence for these controversial remarks, one need only examine the hemovigilance data from Quebec which found that red cells were primarily involved, which argues against antibodies as a cause in most cases, as there is very little plasma in red cell concentrates.  But you might as well follow the standard of practice in your area as to donor workup.  I would only send out antibody testing on donors who have a history of transfusion or pregnancy.

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
  • Recently Browsing   0 members

    • No registered users viewing this page.
  • Advertisement

×
×
  • Create New...

Important Information

We have placed cookies on your device to help make this website better. You can adjust your cookie settings, otherwise we'll assume you're okay to continue.