Two cases of transfusion-related acute lung injury triggered by HLA and anti-HLA antibody reaction

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.

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

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.

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.