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Prepublished online as a Blood First Edition Paper on September 5, 2002; DOI 10.1182/blood-2002-03-0958. This Article Full Text Full Text (PDF) All Versions of this Article: 2002-03-0958v1 101/2/454    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Silliman, C. C. Articles by Ambruso, D. R. Search for Related Content PubMed PubMed Citation Articles by Silliman, C. C. Articles by Ambruso, D. R. Related Collections Transfusion Medicine Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  Blood, 15 January 2003, Vol. 101, No. 2, pp. 454-462 CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS Transfusion-related acute lung injury: epidemiology and a prospective analysis of etiologic factors Christopher C. Silliman, Lynn K. Boshkov, Zahra Mehdizadehkashi, David J. Elzi, William O. Dickey, Linda Podlosky, Gwen Clarke, and Daniel R. Ambruso From the Bonfils Blood Center and the Departments of Pediatrics and Surgery, University of Colorado School of Medicine, Denver; the Department of Pathology, Oregon Health Sciences University, Portland; the American Red Cross, Portland, OR; and the Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada. Transfusion-related acute lung injury (TRALI) is a life-threatening complication of hemotherapy. We report a series of 90 TRALI reactions in 81 patients secondary to transfusion with whole blood platelets (72 reactions), apheresis platelets (2), packed red cells (15), and plasma (1). The overall prevalence was 1 in 1120 cellular components. To examine the epidemiology of TRALI, we completed a nested case-control study of the first 46 patients with TRALI compared with 225 controls who had received transfusions. We then completed a prospective analysis of possible biologic response modifiers responsible for 51 of the TRALI cases, including human leukocyte antigen (HLA) class I, class II, and granulocyte antibodies in donors and neutrophil (PMN) priming activity in the plasma of the implicated units and recipients. Two groups were at risk: patients with hematologic malignancies (P < .0004) and patients with cardiac disease (P < .0006). TRALI was associated with older platelets (P = .014). In the prospective study, antileukocyte antibodies were found in only 3.6% of cases. The implicated blood components had greater PMN priming activity than controls (P < .05), and compared with pretransfusion samples, TRALI patients' plasma demonstrated increases in both interleukin 6 (IL-6) and lipid (neutral lipids and lysophosphatidylcholines) priming activity (P  < .05). We conclude that TRALI may be more frequent than previously recognized and that patient susceptibility, product age, and increased levels of bioactive lipids in components may predispose patients to TRALI. TRALI, like the acute respiratory distress syndrome, may be a 2-event phenomenon with both recipient predisposition and factors in the stored units playing major roles. © 2003 by The American Society of Hematology.   CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: R. S. Jawa, S. Anillo, and M. N. Kulaylat Transfusion-Related Acute Lung Injury J Intensive Care Med, March 1, 2008; 23(2): 109 - 121. 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