What causes transfusion-related acute lung injury (TRALI)?

Updated: Jan 12, 2021
  • Author: S Gerald Sandler, MD, FCAP, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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Neutrophils are the effector cells that adhere to the pulmonary endothelium to increase permeability and cause pulmonary edema. Elements leading to activation of the neutrophils include transfused human leukocyte or neutrophil antigen (HLA or HNA) antibodies and transfused bioactive substances such as lipids or cytokines. Patients with certain clinical conditions (eg, infection, inflammation, surgery) have primed neutrophils that are susceptible to activation by transfused bioactive substances.

Because pregnancy is a common cause of alloimmunization to HLAs and HNAs, most cases of TRALI have been traced to plasma-containing blood components collected from female blood donors. [55] When the American Red Cross converted to predominantly male-donated plasma, the number of cases of TRALI decreased very significantly from 2006 to 2008. [55]

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