SHOT Annual Report 2009 - Serious Hazards of Transfusion

Donor antibodies
Concordant donor HLA antibodies were found in donors of components transfused within 6 hours of the event in 8
cases (5 HLA class I only, 2 both HLA class I and class II, and 1 with HLA class II only). No case had proven concordant
granulocyte antibodies but 1 recipient of massive transfusion received cryoprecipitate containing HNA-3a antibodies in
addition to components from 4 other donors with concordant HLA class I antibodies. In this case, a sample from the
patient was not obtained for crossmatch to assess concordance of the HNA-3a antibody but the frequency of HNA-3a is
99% in Europeans making it highly likely that it would have been concordant.
All donors found to have concordant leucocyte antibodies were female. Males with a history of transfusion were
investigated but none was identified with concordant antibodies. Untransfused males were generally investigated
only if all other donors had been investigated and excluded and no other likely cause for respiratory deterioration
was present. All individuals who have been transfused since 1980 have been excluded from donation in the UK since
2004.
Patient antibodies
Testing for HLA and HNA antibodies in patients is no longer routinely performed because all components except
granulocytes are now leucodepleted in the UK. Such testing is now confined to recipients of granulocytes (apheresis or
buffy coat).
Components
All implicated components with proven concordant donor leucocyte antibodies were donated by females. Platelet pools
were implicated in 3 cases; in each of these the implicated donor had contributed only a buffy coat to the unit. Two
cases followed female FFP and 3 followed RBC OA. All cases which occurred following relatively little transfused plasma
(buffy coats and RBC OA) also had other factors which may have caused or contributed to the events.
The reported risk of TRALI in 2009 following transfusion of components with concordant donor leucocyte antibodies was
1 in 6884 issued units of female FFP and 0 cases following male FFP, 1 in 88,771 units of platelets, 1 in 121,555 units
of cryoprecipitate, and 1 in 736,384 RBC.
Table 41
Cases with concordant donor antibodies – specificities and implicated components
ANTIBODY SPECIFICITY/IES COMPONENT/S * OTHER RISK FACTORS
HLA class I HLA-B8 FFP None
HLA class I HLA-B45 Platelet pool (buffy coat only)* Possible left ventricular failure
HLA class I HLA-B35 RBC OA Sepsis
HLA class I HLA-A26, B60 Platelet pool (buffy coat only)* 2.1 L positive fluid balance
HLA class I HLA-B44, Cw7 RBC OA x 3, cryoprecipitate x 2
Multiple trauma, shock, pulmonary contusions,
rib fractures, massive transfusion
HLA class I and class II
HLA-B60, DR13,
DR52, DQ6
RBC OA
Ischaemic heart disease, pitting oedema to
below knee before transfusion
HLA class I and class II
HLA-A2, DR13,
DR52, DQ6
FFP
None
HLA class II HLA-DR53 Platelet pool (buffy coat only)* Signs of cardiac failure
* Platelet pools are produced by pooling components from 4 donors. One donor (preferentially male) contributes a whole unit of plasma
(nominally 300 mL) and a buffy coat (platelets suspended in approximately 30 mL of plasma), and 3 other donors (either gender) each
contribute a buffy coat.
110 13. Transfusion-Related Acute Lung Injury (TRALI)