J Korean Med Sci.  2010 Sep;25(9):1398-1403. 10.3346/jkms.2010.25.9.1398.

Two Cases of Transfusion-related Acute Lung Injury Triggered by HLA and Anti-HLA Antibody Reaction

• Lee JH
• Kang ES
• Kim DW

• KMID: 1785927
• DOI: http://doi.org/10.3346/jkms.2010.25.9.1398

Abstract

Transfusion-related acute lung injury (TRALI) is a serious adverse transfusion reaction that is presented as acute hypoxemia and non-cardiogenic pulmonary edema, which develops during or within 6 hr of transfusion. Major pathogenesis of TRALI is known to be related with anti-HLA class I, anti-HLA class II, or anti-HNA in donor's plasma. However, anti-HLA or anti-HNA in recipient against transfused donor's leukocyte antigens also cause TRALI in minor pathogenesis and which comprises about 10% of TRALI. Published reports of TRALI are relatively rare in Korea. In our cases, both patients presented with dyspnea and hypoxemia during transfusion of packed red blood cells and showed findings of bilateral pulmonary infiltrations at chest radiography. Findings of patients' anti-HLA antibodies and recipients' HLA concordance indicate that minor pathogenesis may be not as infrequent as we'd expected before. In addition, second case showed that anti-HLA class II antibodies could be responsible for immunopathogenic mechanisms, alone.

Keyword

Adverse Transfusion Reaction; Transfusion-Related Acute Lung Injury (TRALI); Anti-HLA Antibody

MeSH Terms

Acute Lung Injury/*diagnosis/*immunology/radiography
Aged
Anoxia/diagnosis
Antigen-Antibody Reactions
Blood Transfusion/*adverse effects
Dyspnea/diagnosis
Female
HLA Antigens/*immunology
Histocompatibility Antigens Class I/immunology
Histocompatibility Antigens Class II/immunology
Humans
Isoantibodies/*blood
Male
Middle Aged

Figure

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  Fig. 1 Chest radiography of the Case 1. (A) 1 day before the transfusion of packed red blood cells (B) shortly after TRALI develops, showing aggravated bilateral lung infiltrations with pleural effusion.

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  Fig. 2 Chest radiography of the Case 2. (A) 4 day before the transfusion of platelet concentrates and packed red blood cells, showing mild pulmonary edema (B) shortly after TRALI develops, showing aggravated bilateral lung infiltrations.

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