Transfusion related acute lung injury (TRALI) prevention - selection of donors for producing plasma designated for clinical use
Abstract
Transfusion related acute lung injury (TRALI) is a life-threatening complication of transfusions characterized by the development of acute respiratory distress occurring within 6 h following a blood transfusion. Leukocyte alloantibodies in the plasma of the transfused blood products and patient leukocytes play a leading role in the pathogenesis of TRALI.
Reduction of TRALI risk is possible by implementing donor selection and by processing blood components. The objective of this study was to quantify the implementation of TRALI reduction interventions in the Czech Republic in 2019.
The questionnaire sent out was completed by 51 blood banks (100%). Plasma for clinical use was produced by 47 blood banks (BB) in 2019. 37 BB (78.7%) implemented strategies to reduce the incidence of TRALI from their plasma blood components. 17 BB provided plasma from male donors without a history of transfusions, 13 BB used plasma from male donors without a history of transfusions and female donors without a history of pregnancy and transfusions, 7 BB used plasma from male donors, but did not determine their transfusion history. 5 BB performed additional testing of leukocyte antibodies. 10 BB did not perform any interventions to reduce TRALI risk.
For 5 BB, the implementation of interventions would be complicated due to shortage of plasma products, logistical requirements, storage facilities, computer system modifications, risk of plasma deterioration and more expensive production. From 2012 to 2019, the number of BB that introduced the TRALI risk reduction policy increased from 24 to 37.
The proportion of TRALI safe plasma has risen from 50% to more than 75%. Due to the occurrence of serious TRALI reactions in the Czech Republic between 2014-2019, further preventive measures are desirable.