Retrospective study on transfusion-related acute lung injury after intraoperative and postoperative blood transfusion in patients at a single medical center

Transfusion-related acute lung injury (TRALI) is a life-threatening syndrome that occurs within six hours of a blood transfusion. The objective of this study was to investigate the characteristics, clinical manifestations, outcomes, and risk factors of TRALI in patients who underwent surgery at a single medical centre of China. The retrospective study included 5,846 patients who received intraoperative and postoperative blood transfusions. All donors implicated in TRALI cases were tested for anti-HLA class I and II antibodies using LABScreen Multi assay and for granulocyte antibodies using granulocyte agglutination test. Four patients (4/5846, 0.068%) developed TRALI, with specific incidence of 0.26/100,000 blood product; 9/10,000 units of packed red blood cells (PRBC) (1/1,065); 16/10,000 units of fresh frozen plasma (FFP) (1/645); and 5/10,000 units of Apheresis platelets (AP)(1/2,120). In one patient, TRALI was found to be secondary to a human leukocyte antigen (HLA) class I antibody (anti-HLA-A*11); in another, it was secondary to an HLA class II antibody (anti-HLA-DRB*04). The one with possibility of reverse TRALI was identified as a result of anti-A*24. One of the four patients was non-immunologically mediated TRALI. To reduce the incidence and prevent TRALI, it is recommended that male donors and female donors who have never been pregnant or have tested negative for HLA antibodies since their last pregnancy should be selected for blood donation as much as possible. In addition, it is important to initiate clinical intervention and treatment at an early stage in order to improve the patient's prognosis.