Blood Journal
Leading the way in experimental and clinical research in hematology

Transfusion-related acute lung injury: incidence and risk factors

  1. Pearl Toy1,
  2. Ognjen Gajic2,
  3. Peter Bacchetti1,
  4. Mark R. Looney1,
  5. Michael A. Gropper1,
  6. Rolf Hubmayr2,
  7. Clifford A. Lowell1,
  8. Philip J. Norris1,3,
  9. Edward L. Murphy1,3,
  10. Richard B. Weiskopf1,
  11. Gregory Wilson2,
  12. Monique Koenigsberg1,
  13. Deanna Lee1,
  14. Randy Schuller4,
  15. Ping Wu1,
  16. Barbara Grimes1,
  17. Manish J. Gandhi2,
  18. Jeffrey L. Winters2,
  19. David Mair4,
  20. Nora Hirschler1,5,
  21. Rosa Sanchez Rosen1,3,
  22. Michael A. Matthay1, and
  23. for the TRALI Study Group
  1. 1University of California–San Francisco, San Francisco, CA;
  2. 2Mayo Clinic, Rochester, MN;
  3. 3Blood Systems Research Institute, San Francisco, CA;
  4. 4American Red Cross Neutrophil Reference Laboratory, St Paul, MN; and
  5. 5Blood Centers of the Pacific, San Francisco, CA


Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. To determine TRALI incidence by prospective, active surveillance and to identify risk factors by a case-control study, 2 academic medical centers enrolled 89 cases and 164 transfused controls. Recipient risk factors identified by multivariate analysis were higher IL-8 levels, liver surgery, chronic alcohol abuse, shock, higher peak airway pressure while being mechanically ventilated, current smoking, and positive fluid balance. Transfusion risk factors were receipt of plasma or whole blood from female donors (odds ratio = 4.5, 95% confidence interval [CI], 1.85-11.2, P = .001), volume of HLA class II antibody with normalized background ratio more than 27.5 (OR = 1.92/100 mL, 95% CI, 1.08-3.4, P = .03), and volume of anti–human neutrophil antigen positive by granulocyte immunofluoresence test (OR = 1.71/100 mL, 95% CI, 1.18-2.5, P = .004). Little or no risk was associated with older red blood cell units, noncognate or weak cognate class II antibody, or class I antibody. Reduced transfusion of plasma from female donors was concurrent with reduced TRALI incidence: 2.57 (95% CI, 1.72-3.86) in 2006 versus 0.81 (95% CI, 0.44-1.49) in 2009 per 10 000 transfused units (P = .002). The identified risk factors provide potential targets for reducing residual TRALI.

  • Submitted August 11, 2011.
  • Accepted November 21, 2011.
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