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Ten years of hemovigilance reports of transfusion-related acute lung injury in the United Kingdom and the impact of preferential use of male donor plasma

Authors

  • Catherine E. Chapman,

    1. From the NHS Blood and Transplant, Newcastle, Manchester, Bristol, Tooting, Colindale, and Cambridge; Serious Hazards of Transfusion, Manchester; Chelsea and Westminster NHS Trust, Royal Brompton NHS Trust, Medical Research Council Clinical Trials Unit, and University College London Hospitals NHS Foundation Trust, London; and the Department of Haematology, University of Cambridge, Cambridge, UK.
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  • Dorothy Stainsby,

    1. From the NHS Blood and Transplant, Newcastle, Manchester, Bristol, Tooting, Colindale, and Cambridge; Serious Hazards of Transfusion, Manchester; Chelsea and Westminster NHS Trust, Royal Brompton NHS Trust, Medical Research Council Clinical Trials Unit, and University College London Hospitals NHS Foundation Trust, London; and the Department of Haematology, University of Cambridge, Cambridge, UK.
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  • Hilary Jones,

    1. From the NHS Blood and Transplant, Newcastle, Manchester, Bristol, Tooting, Colindale, and Cambridge; Serious Hazards of Transfusion, Manchester; Chelsea and Westminster NHS Trust, Royal Brompton NHS Trust, Medical Research Council Clinical Trials Unit, and University College London Hospitals NHS Foundation Trust, London; and the Department of Haematology, University of Cambridge, Cambridge, UK.
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  • Elizabeth Love,

    1. From the NHS Blood and Transplant, Newcastle, Manchester, Bristol, Tooting, Colindale, and Cambridge; Serious Hazards of Transfusion, Manchester; Chelsea and Westminster NHS Trust, Royal Brompton NHS Trust, Medical Research Council Clinical Trials Unit, and University College London Hospitals NHS Foundation Trust, London; and the Department of Haematology, University of Cambridge, Cambridge, UK.
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  • Edwin Massey,

    1. From the NHS Blood and Transplant, Newcastle, Manchester, Bristol, Tooting, Colindale, and Cambridge; Serious Hazards of Transfusion, Manchester; Chelsea and Westminster NHS Trust, Royal Brompton NHS Trust, Medical Research Council Clinical Trials Unit, and University College London Hospitals NHS Foundation Trust, London; and the Department of Haematology, University of Cambridge, Cambridge, UK.
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  • Nay Win,

    1. From the NHS Blood and Transplant, Newcastle, Manchester, Bristol, Tooting, Colindale, and Cambridge; Serious Hazards of Transfusion, Manchester; Chelsea and Westminster NHS Trust, Royal Brompton NHS Trust, Medical Research Council Clinical Trials Unit, and University College London Hospitals NHS Foundation Trust, London; and the Department of Haematology, University of Cambridge, Cambridge, UK.
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  • Cristina Navarrete,

    1. From the NHS Blood and Transplant, Newcastle, Manchester, Bristol, Tooting, Colindale, and Cambridge; Serious Hazards of Transfusion, Manchester; Chelsea and Westminster NHS Trust, Royal Brompton NHS Trust, Medical Research Council Clinical Trials Unit, and University College London Hospitals NHS Foundation Trust, London; and the Department of Haematology, University of Cambridge, Cambridge, UK.
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  • Geoff Lucas,

    1. From the NHS Blood and Transplant, Newcastle, Manchester, Bristol, Tooting, Colindale, and Cambridge; Serious Hazards of Transfusion, Manchester; Chelsea and Westminster NHS Trust, Royal Brompton NHS Trust, Medical Research Council Clinical Trials Unit, and University College London Hospitals NHS Foundation Trust, London; and the Department of Haematology, University of Cambridge, Cambridge, UK.
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  • Neil Soni,

    1. From the NHS Blood and Transplant, Newcastle, Manchester, Bristol, Tooting, Colindale, and Cambridge; Serious Hazards of Transfusion, Manchester; Chelsea and Westminster NHS Trust, Royal Brompton NHS Trust, Medical Research Council Clinical Trials Unit, and University College London Hospitals NHS Foundation Trust, London; and the Department of Haematology, University of Cambridge, Cambridge, UK.
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  • Cliff Morgan,

    1. From the NHS Blood and Transplant, Newcastle, Manchester, Bristol, Tooting, Colindale, and Cambridge; Serious Hazards of Transfusion, Manchester; Chelsea and Westminster NHS Trust, Royal Brompton NHS Trust, Medical Research Council Clinical Trials Unit, and University College London Hospitals NHS Foundation Trust, London; and the Department of Haematology, University of Cambridge, Cambridge, UK.
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  • Louise Choo,

    1. From the NHS Blood and Transplant, Newcastle, Manchester, Bristol, Tooting, Colindale, and Cambridge; Serious Hazards of Transfusion, Manchester; Chelsea and Westminster NHS Trust, Royal Brompton NHS Trust, Medical Research Council Clinical Trials Unit, and University College London Hospitals NHS Foundation Trust, London; and the Department of Haematology, University of Cambridge, Cambridge, UK.
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  • Hannah Cohen,

    1. From the NHS Blood and Transplant, Newcastle, Manchester, Bristol, Tooting, Colindale, and Cambridge; Serious Hazards of Transfusion, Manchester; Chelsea and Westminster NHS Trust, Royal Brompton NHS Trust, Medical Research Council Clinical Trials Unit, and University College London Hospitals NHS Foundation Trust, London; and the Department of Haematology, University of Cambridge, Cambridge, UK.
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  • Lorna M. Williamson

    1. From the NHS Blood and Transplant, Newcastle, Manchester, Bristol, Tooting, Colindale, and Cambridge; Serious Hazards of Transfusion, Manchester; Chelsea and Westminster NHS Trust, Royal Brompton NHS Trust, Medical Research Council Clinical Trials Unit, and University College London Hospitals NHS Foundation Trust, London; and the Department of Haematology, University of Cambridge, Cambridge, UK.
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Errata

This article is corrected by:

  1. Errata: ERRATA Volume 51, Issue 12, 2746, Article first published online: 12 December 2011

  • This study was funded by the UK Blood Services.

Dr Catherine Chapman, NHS Blood and Transplant, Holland Drive, Barrack Road, Newcastle Upon Tyne NE2 4NQ, UK; e-mail: catherine.chapman@nhsbt.nhs.uk.

Abstract

BACKGROUND AND METHODS: From 1996 through 2006, 195 cases were reported as transfusion-related acute lung injury (TRALI) to the Serious Hazards of Transfusion scheme and from 1999 onward classified by probability, using clinical features and HLA and/or HNA typing. From late 2003, the National Blood Service provided 80 to 90 percent of fresh-frozen plasma (FFP) and plasma for platelet (PLT) pools from male donors.

RESULTS: Forty-nine percent of reports were highly likely/probable TRALI, and 51 percent possible/unlikely. Of 96 investigations, donor antibodies recognizing recipient antigens were found in 73 cases (65%), with HLA Class I in 25 of those (40%), HLA Class II antibodies in 38 (62%), and granulocyte antibodies in 12 (17%). A review in 2003 revealed that the TRALI risk/component was 6.9 times higher for FFP and 8.2 times higher for PLTs than for red blood cells, and that in donors of implicated FFP/PLTs, white blood cell antibodies were found 3.6 times more often than by chance (p ≤ 0.0001), with all implicated donors being female. Provision of male plasma was associated with a reduction in TRALI reports from 36 in 2003 to 23 in each of 2004 and 2005 and 10 in 2006. Highly likely/probable cases reduced from 23 in 2003 to 10, 6, and 4 in the 3 subsequent years, with cases implicating FFP or PLTs falling from 16 to 9, 3, and 1 respectively.

CONCLUSIONS: The risk of highly likely/probable TRALI due to FFP has fallen from 15.5 per million units issued during 1999 through 2004 to 3.2 per million during 2005 through 2006 (p = 0.0079) and from 14.0 per million to 5.8 per million for PLTs.

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