PMID- 33666248
OWN - NLM
STAT- MEDLINE
DCOM- 20210719
LR  - 20210719
IS  - 1537-2995 (Electronic)
IS  - 0041-1132 (Linking)
VI  - 61
IP  - 4
DP  - 2021 Apr
TI  - A possible case of recipient anti-neutrophil and anti-human leukocyte antigen 
      antibody-mediated fatal reverse transfusion-related acute lung injury.
PG  - 1336-1340
LID - 10.1111/trf.16330 [doi]
AB  - BACKGROUND: Transfusion-related acute lung injury (TRALI) is a transfusion 
      complication often mediated by recipient exposure to plasma from donors with 
      human leukocyte antigen (HLA) and human neutrophil antigen (HNA) antibodies. 
      Recipient anti-donor HLA or HNA antibodies have rarely been implicated. STUDY 
      DESIGN AND METHODS: Herein, we describe a case of fatal TRALI mediated by 
      recipient anti-HLA and anti-HNA antibodies. Cognate antibody-antigen match was 
      confirmed with serologic and molecular assays. RESULTS: A 69-year-old G5P5 female 
      with no prior transfusion history and metastatic cholangiocarcinoma with 
      thromboembolic complications presented with heart failure and dyspnea. She was 
      transfused 15 ml of a unit of Fy(a) -negative red blood cells and subsequently 
      developed acute onset dyspnea, hypoxemia, hypotension, and fever. Clinical 
      investigations revealed bilateral infiltrates on chest X-ray and cognate 
      recipient HLA and HNA antibodies to donor antigens. The patient died of acute 
      respiratory failure within 24 h of transfusion. In total, the patient had Fy(a) , 
      HLA Class I, HNA, and human platelet antigen (HPA) alloantibodies. The 
      63-year-old female donor had detectable HLA class II antibodies (recipient class 
      II genotype unavailable). CONCLUSION: The pathophysiology of TRALI has 
      traditionally been ascribed to underlying conditions that put the recipient at 
      risk in combination with donor biological response modifiers. This case 
      illustrates alternative pathogenic mediators including alloantibodies to donor 
      HLA and HNA. Additional studies to determine the contribution and frequency of 
      recipient alloantibodies in TRALI may inform future mitigation strategies to 
      further reduce the incidence of TRALI, particularly in female transfusion 
      recipients.
CI  - (c) 2021 AABB.
FAU - Jug, Rachel
AU  - Jug R
AUID- ORCID: 0000-0001-9858-8292
AD  - Canadian Blood Services, Toronto, Ontario, Canada.
FAU - Anani, Waseem
AU  - Anani W
AUID- ORCID: 0000-0003-2715-642X
AD  - Canadian Blood Services, Toronto, Ontario, Canada.
FAU - Callum, Jeannie
AU  - Callum J
AUID- ORCID: 0000-0001-6133-0677
AD  - Department of Pathology and Molecular Medicine, Queen's University and Kingston 
      Health Sciences Centre, Kingston, Ontario, Canada.
LA  - eng
PT  - Case Reports
PT  - Research Support, Non-U.S. Gov't
DEP - 20210305
PL  - United States
TA  - Transfusion
JT  - Transfusion
JID - 0417360
RN  - 0 (HLA Antigens)
RN  - 0 (Isoantibodies)
SB  - IM
MH  - Aged
MH  - Blood Donors
MH  - Cholangiocarcinoma/complications/*secondary
MH  - Dyspnea/etiology
MH  - Fatal Outcome
MH  - Female
MH  - Fever/etiology
MH  - HLA Antigens/*immunology
MH  - Humans
MH  - Hypotension/etiology
MH  - Hypoxia/etiology
MH  - Isoantibodies/blood
MH  - Middle Aged
MH  - Neutrophils/*immunology
MH  - Plasma/immunology
MH  - Respiratory Distress Syndrome/diagnosis/etiology
MH  - Thromboembolism/etiology
MH  - Transfusion Reaction/complications
MH  - Transfusion-Related Acute Lung 
      Injury/complications/*diagnosis/immunology/physiopathology
MH  - Transplant Recipients
OTO - NOTNLM
OT  - HLA
OT  - HNA
OT  - RBC
OT  - TRALI
OT  - human neutrophil antibody
OT  - red blood cell
EDAT- 2021/03/06 06:00
MHDA- 2021/07/20 06:00
CRDT- 2021/03/05 08:39
PHST- 2021/02/03 00:00 [revised]
PHST- 2021/01/21 00:00 [received]
PHST- 2021/02/06 00:00 [accepted]
PHST- 2021/03/06 06:00 [pubmed]
PHST- 2021/07/20 06:00 [medline]
PHST- 2021/03/05 08:39 [entrez]
AID - 10.1111/trf.16330 [doi]
PST - ppublish
SO  - Transfusion. 2021 Apr;61(4):1336-1340. doi: 10.1111/trf.16330. Epub 2021 Mar 5.