Cases Of TRALI Research Articles

SHOT–A Voluntary System for the Reporting of Serious Hazards of Transfusion in the UK

SUMMARy Background: From 1996–2001 the SHOT scheme has collected a powerful body of data on serious transfusion complications in the UK from which to make firm recommendations for improvements in transfusion safety. The UK Blood Services issue approximately 3.5 million blood components annually. Results: With 413 eligible hospitals on the scheme, by year five, participation was running at 92%. Of 1,148 fully analyzed reports there were 699 (61%) “wrong blood” incidents. Of these, 161 were ABO incompatible transfusions leading to 11 deaths and 60 cases of major morbidity and 73 were RhD incompatible leading to potential RhD sensitization in 17 young females. Multiple errors occurred in 49% of cases. 55% of errors involved mis‐identification at the point of collection from the hospital storage site and/or bedside administration, whilst laboratories and prescription/sampling/request errors contributed 28% and <13% respectively. Immune complications comprised 35.7% of reports. 70 cases of possible TRALI over 5 years resulted in 49 cases of major morbidity and up to 20 deaths possibly related to transfusion. Transfusion‐transmitted infection (TTI) comprised < 3% of reports but of 39 confirmed TTIs 25 were bacterial contamination incidents (21 platelets, 4 red cells) resulting in 6 deaths (5 platelets; one red cells). Recommendations:“Wrong blood” incidents are avoidable errors. Efforts should be directed at developing computerized bedside identification systems to reduce human error. These can be linked to secure systems to reduce errors at the point of collection from storage and are also applicable in the drugs administration setting. Options to reduce the incidence of TRALI should be explored. Possible strategies to reduce bacterial contamination should be given appropriate priority.

TRALI: correlation of antigen-antibody and monocyte activation in donor-recipient pairs.

TRALI may be a severe reaction associated with transfusion of plasma-containing blood components. TRALI has usually been associated with antibodies against granulocytes and HLA class I antigens, but more recently with antibodies against HLA class II and monocytes. TRALI cases were investigated to determine correlation between antigen and antibody. Additionally, activation of monocytes by TRALI serums was studied. Sixteen cases of TRALI were investigated. All patients were typed for HLA antigens. Implicated donors were screened for HLA antigens and antibodies against granulocytes and monocytes. In 6 cases, recipient monocyte activation was measured in vitro after incubation with TRALI and control serums. In four cases, monocyte activation was measured after incubation of TRALI serums against a panel of monocytes of known HLA antigen type. In 14 of the 16 cases (87.5%), antigen-antibody correlation was identified. TRALI monocytes, incubated with implicated TRALI serum (n = 6), expressed significantly greater cytokine and tissue factor (p < 0.05, repeated-measures ANOVA) than controls. Panel monocytes incubated with TRALI serum showed increased expression of cytokine and/or tissue factor when corresponding antigen was present. In most cases of TRALI, a correlation between antigen and antibody can be identified. Activation of monocytes and their subsequent release of cytokines may play a role in the pathogenesis of TRALI.