133
Number of Adverse Reactions
140
118 113
120 112
95
100
80 Total AR
60 45 48 46 TRALI
42
40 30
17
20 10
0
2001 2002 2003 2004 2005 2006
Evolution of Transfusion Risks
HIV and HCV vs TRALI
1 / 102
HIV
Transfusion Risk per Unit
HCV
1 / 103
Estimated TRALI risk
1 / 104
1 / 106
Recipient WBC
- Neutrophils
- Lymphocytes
- Monocytes
Courtesy of Y. Lin
Clinical Correlation
Right, single lung transplant
+FMLP
Release of substances
causing pulmonary
endothelial damage
and capillary leak
Activation of pulmonary
endothelium with increased
adhesion molecules
2007-02-10
received 2 units red cells uneventfully as an outpatient.
Discharged but became acutely SOB on way home,
returned to ER
CXR showed bilateral new infiltrates
Decreased sats, intubated and ventilated for 30 hours
then extubated and recovered.
Results of Investigation
Recipient results: post- sample: Negative
2007-03-19
Had been discharged home receiving regular outpatient
transfusions 2x/week
after transfusion of 2 units of RCC developed new onset
SOB, new CXR infiltrates and PO2<60.
Required mechanical ventilation.
Results of Investigation
Recipient results: pre-samples: positive anti HLA
post-sample: positive anti HLA
No crossmatch done
EVPE (µl)
80 100
60 80
60
40
40
20 20
0 0
80
60 **
40
20
0
15 30 45 60 75 90 105 120
(Minutes)
Evidence from animal models
• The MHC Class I mAb binds
throughout the body and prominently
in the lung microvasculature.
• The investigators demonstrated that
this antibody also binds to
neutrophils, but does not cause direct
neutrophil activation.
+FMLP
TRALI 36 23 23
Highly 22 13 6
likely/probable
SHOT data
10 years hemovigilance in UK and impact of
preferential use of male donor plasma
Risk of highly likely/probable TRALI due to
FFP decreased
15.5 per million units 1999-2004
3.2 per million units issued 2005-2006 (p=
0.0079)
Risk of highly likely/probable TRALI due to
platelets decreased
14 per million to 5.8 per million
Chapman.Transfusion 2009;49:440-452
TRALI reduction measures CBS-
predominantly male plasma
CBS moved to predominantly male
plasma for transfusion Oct 2008
Female plasma diverted fractionation
TRALI the CBS Experience – Definite and Possible
Year 2001 2002 2003 2004 2005 2006 2007 2008 2009
Q1
Total 6 6 6 16 14 21 35 19* 1
Tor 4 6 6 10 6 10 26 5 1
Edm 1 0 0 3 3 1 0 0* 0
TRALI Reduction Measures –
Platelet Apheresis
20.0 K 25.0%
18.0 K 22.5%
16.0 K 20.0%
Imports and Issues
14.0 K 17.5%
% Imports / Issue
12.0 K 15.0%
10.0 K 12.5%
8.0 K 10.0%
6.0 K 7.5%
4.0 K 5.0%
2.0 K 2.5%
0.0 K 0.0%
2004/05 2005/06 2006/07 2007/08 2008/09
Imports 650 1,335 2,344 3,642 2,559
Issues 12,829 14,318 15,599 17,412 17,719
% Imports/Issue 5% 9% 15% 21% 14%
F2008/09 reversed the trend of large rises in the number of platelet imports.
TRALI – Platelet Apheresis
In BC, LVPs allowed CBS to continue to meet
platelet demand with fewer imports
Questions?