What to do about transfusion‐related acute lung injury?

Abstract

BackgroundIn recent years, blood centres in several countries have taken measures to effectively reduce the risk of transfusion‐related acute lung injury (TRALI) from plasma transfusion but challenges remain.MethodsThis article reviews recently published studies and data on TRALI from the American Red Cross haemovigilance programme.ResultsSince 2008, over 95% of the approximately 1·6 million plasma components distributed annually for transfusion by the American Red Cross is from male donors. With this approach, the rate of TRALI after plasma transfusion decreased by about 80%. However, the risk associated with group AB plasma compared to other blood groups did not change, because female donors were still needed for almost half of the group AB plasma to meet demand. Between 2006 and 2011, the use of group AB plasma in the United States steadily increased by over 30%, while plasma use overall decreased by about 3%. To meet the new standard for plasma safety, US blood centres and transfusion services took additional measures to ensure an adequate supply of group AB plasma and appropriate utilization of a limited resource.SummaryThe switch to a male‐donor predominant plasma strategy resulted in a sustained and significant reduction in the risk of TRALI. The collaborative effort of blood centres and transfusion services to further advance evidence‐based haemotherapy practices will likely have a broader effect on transfusion safety than in preventing TRALI alone.