Transfusionrelated acute lung injury (TRALI-syndrome) in critical states and its prevention measures

Aim. To study the prevalence of transfusion-related acute lung injury (TRALI).

Material and methods. A retrospective and prospective analysis of the medical histories of 3,750 women in labour and postpartum women with class III-IV (WHO) haemorrhage, 756 patients with acute gastroduodenal haemorrhage of ulcerative etiology, 150 victims of polytrauma complicated by massive haemorrhage was undertaken. In addition, the results of transfusion therapy of 7,325 oncological and haematological patients hospitalised at the Research Institute of Paediatric Oncology, Haematology and Transplantation named after R. Gorbacheva were analysed.

Results and discussion. TRALI was diagnosed in 24 patients and “possible TRALI” in 5 obstetric patients, or 0.77% of cases. The frequency of TRALI and “possible TRALI” was 1 case per transfusion of 870.3 doses of donated blood and blood components. In surgical patients - 4 and 2 (0.79%) respectively (1 case per transfusion out of 765 doses of blood components). In polytrauma patients, the diagnosis of “possible TRALI” was made in 3 patients (2.0%). 4 cases of TRALI and 5 cases of “possible TRALI” were diagnosed in patients with oncological and oncohematological profiles. The frequency of TRALI and “possible TRALI” was 1 case per 16,155 transfusions.

Conclusion. Transfusion of blood components is a high risk factor for the development of TRALI, especially from female donors with a history of multiple pregnancies and childbirth. In order to prevent TRALI, it is necessary to screen the blood of female donors for the presence of anti-HNA, anti-HLA antibodies, or to discontinue the clinical use of plasma-containing components of blood from female donors and to arrange for the preparation of platelet concentrate in an additional solution.

1. Klinicheskoe ispolzovanie eritrotsitsoderzhashchikh komponentov donorskoy krovi. Klinicheskie rekomendatsii. Pod red. B.A. Akselroda, E.N. Balashovoy, A.E. Bautina i dr. [Clinical use of erythrocyte-containing components of donor blood. Clinical recommendations. Edited by B.A. Akselrod, E.N. Balashova, A.E. Bautin et al.] Gematologiya i transfuziologiya - Hematology and transfusiology, 2018, Vol. 63, No. 4, pp. 372-435.

2. Bakhovadinov B.B., Ashurova G.S., Kucher M.A. O sluchayakh transfuzionno-assotsiirovanogo povrezhdeniya legkikh v klinicheskoy praktike [On cases of transfusion-associated lung injury in clinical practice]. Uchenye zapiski - Scientific notes, 2015, Vol. 22, No. 3, pp. 29-35.

3. Bakhovadinov B.B., Ashurzoda G.S., Odinazoda A.A., Dodkhoeva M.F., Baryshev B.A. O chastote transfuzionno-assotsirovannogo povrezhdeniya legkikh v akusherskoy praktike [On the frequency of transfusion-associated lung injury in obstetric practice]. Transfuziologiya - Transfusiology, 2022, Vol. 23, No. 2, pp. 8-10.

4. Vasilev D.A., Tsentsiper L.M. Transfuzionno-assotsiirovannoe povrezhdenie legkikh [Transfusion-associated lung injury]. Anesteziologiya i reanimatologiya - Anesthesiology and resuscitation, 2017, No. 3 (63), pp. 240-242.

5. Transfuziologiya: Natsionalnoe rukovodstvo. Pod red. A.A. Ragimova [Transfusiology: National Guide. Edited by A.A. Ragimov]. Moscow, GEOTAR-Media Publ., 2018. 2091 p.

6. Rukovodstvo Soveta Evropy po prigotovleniyu, ispolzovaniyu i garantii kachestva komponentov krovi. Evropeyskiy direktorat po kachestvu lekarstvennykh sredstv i zdravookhraneniyu (EDQM) [Council of Europe Guidelines for the Preparation, Use and Quality Assurance of Blood Components. European Directorate for the Quality of Medicines and Healthcare (EDQM)]. 2023. 459 p.

7. Soldatenkov V.E., Chechetkin A.V., Mineeva N.V., Bessmeltsev S.S. Kliniko-laboratornaya diagnostika reaktsiy i oslozhneniy, svyazannykh s transfuziey donorskoy krovi i ee komponentov, v uchrezhdeniyakh zdravookhraneniya. Metodicheskie rekomendatsii [Clinical and laboratory diagnostics of reactions and complications associated with transfusion of donor blood and its components in healthcare institutions. Methodological recommendations]. St. Petersburg, 2020. 36 p.

8. Annual Serious Hazards of Transfusion (SHOT) report 2017. Available at: https://www.shotuk.org/wp-content/uploads/myimages/SHOT-Report-2017WEB-Final-v4-25-9-18.pdf

9. Bakhovadinov B.B., Kucher M.A., Ashurzoda G.S., Kubiddinov A.F., Odinazoda A.A. Transfusion reactions frequency in the Republic of Tajikistan. Vox Sanguinis, 2023, Vol. 118 (Suppl. 1), pp. 348-349.

10. Boffard K.D., Riou B., Warren B. Recombinant factor V11a as adjunctive therapy for bleeding control in severely injured trauma patients: Two parallel randomized, placebo-controlled, double-bind clinical trials. The Journal of Trauma, 2005, No. 59, pp. 8-15.

11. Cajic O., Rana R., Winters J.I. Transfusion-related acute lung injury in the critically ill. Prospective nested case-control study. American Journal of Respiratory and Critical Care Medicine, 2007, Vol. 176, pp. 886-891.

12. Curtis B.R., McFarland J.G. Mechanisms of transfusion-related acute lung injury (TRALI): anti-leukocyte antibodies. Critical Care Medicine, 2006, No. 34, pp. 118-S123.

13. Fatalities Reported to Food and Drug Administration (FDA) Following Blood Collection and Transfusion; Annual summary for fiscal year 2016. Lancet, 2013, Vol. 382 (9896), pp. 984-994.

14. Guide to the preparation, use and quality assurance of blood components // European Directorate for the quality of medicines and healthcare (EDQM). Council of Europe, 2017, pp. 23-440.

15. Nguyen X.D., Schulze T.J., Bugert P. Granulocyte antibodies in male blood donors: can they trigger transfusion-related acute lung injury? Transfusion, 2018, Vol. 58, No. 8, pp. 1894-1901.

16. Peak D.K., Davis W.T., Walton S.B. Late presentation of transfusion-related acute lung injury in the emergency department. Clinical Practice and Cases in Emergency Medicine, 2019, No. 7, pp. 33-35.

17. Peters A.L., van Hezel M.E., Juffermans N.P., Vlaar A.P. Pathogenesis of non-antibody mediated transfusion-related acute lung in- jury from bench to bedside. Blood Reviews, 2015, Vol. 29 (1), pp. 51-61.

18. Peters A.L., Van Stein D., Vlaar A.P. Antibody- mediated transfusion-related acute lung injury; from discovery to prevention. British Journal of Haematology, 2015, Vol. 170 (5), pp. 597-614.

19. Politis C., Wiersum J.C., Richardson C. The international haemovigilance network database for the surveillance of adverse reactions and events in donors and recipients of blood components: Technical issues and results. Vox Sanguinis, 2016, No. 111, pp. 409-417.

20. Popovsky M.A., Audet A.M., Andrzejewski C.Jr. Transfusion-associated circulatory overload in orthopedic surgery patients: a multi-institutional study. Immunohematology, 1996, Vol. 12 (2), pp. 87-89.

21. Sandler S.G., Han S., Langeberg A. Nonhemolytic passenger lymphocyte syndrome. Transfusion, 2017, No. 57 (12), pp. 2942-2945.

22. Semple J.W., Rebetz J., Kapur R. Transfusion- associated circulatory overload (TACO): Time to shed light on the pathophysiology. ISBT Science Series, 2019, Vol. 14 (1), pp. 136-139.

23. Toy P., Kleinman S.H., Looney M.R. Proposed revised nomenclature for transfusion-related acute lung injury. Transfusion, 2017, Vol. 57 (3), pp. 709-713.

24. van Stein D., Beckers E.A., Peters A.L. Underdiagnosing of antibody-mediated transfusion-related acute lung injury: evaluation of cellular-based versus bead-based techniques. Vox Sanguinis, 2016, Vol. 111 (1), pp. 71-78.