A case of transfusion-related acute lung injury induced by anti-human leukocyte antigen antibodies in acute leukemia

Abstract

Transfusion-related acute lung injury (TRALI) is a noncardiogenic pulmonary edema that occurs during or within 6 hours after transfusion. Risk factors for TRALI, which is relatively common in critically ill patients, include recent surgery, hematologic malignancy, and sepsis. Here, we report a case of TRALI induced by anti-human leukocyte antigen (anti-HLA) class II antibodies (HLA-DR) occurring after transfusion of platelet concentrates in a patient with acute leukemia. Although most patients with TRALI show improvement within 48-96 hours, our patient's condition rapidly worsened, and he did not respond to supportive treatment. TRALI is a relatively common and serious adverse transfusion reaction that requires prompt diagnosis and management.

Keywords: Anti-human leukocyte antigen (anti-HLA) antibody; Transfusion; Transfusion-related acute lung injury (TRALI).

Fig. 1

Chest radiographs (A) 7 hours before transfusion, revealing bilateral upper lung lesions of stable pulmonary tuberculosis, (B) after the transfusion, revealing newly developed diffuse bilateral patch opacities in mostly the right middle and lower lung and the left whole lung without cardiomegaly or pleural effusion, suggesting pulmonary edema.