Transfusion-related acute lung injury: transfusion, platelets and biological response modifiers

ABSTRACT

Transfusion-related acute lung injury (TRALI) may be induced by plasma, platelet concentrates and red blood cell concentrates. The mechanism leading to TRALI is thought to involve two steps. The priming step consists of previous inflammatory pathological conditions or external factors attracting leukocytes to lung vessels and creating conditions favorable for the second step, in which anti-HLA or anti-HNA antibodies or biologically active lipids, usually in transfused blood products, stress leukocytes and inflame lung epithelia. Platelets may be involved in the pathogenesis of TRALI because of their secretory potential and capacity to interact with other immune cells. There is no drug based-prophylaxis, but transfusion strategies are used to mitigate the risk of TRALI.

KEYWORDS:

• Platelet
• inflammation
• biological response modifiers
• TRALI
• transfusion

Acknowledgments

The authors wish to thank Charles Antoine Arthaud, Marie Ange Eyraud and Jocelyne Fagand for their invaluable contributions. We would like to thank the medical staff and personnel of Etablissement Français du Sang Auvergne-Loire, Saint-Etienne, France for their technical support throughout our studies.

Financial and competing interests disclosure

This work was supported by grants from the French National Blood Service – EFS (Grant APR), France; the Association for Research in Transfusion (ART), Paris, France; the Agence Nationale de la Sécurité et du Médicament et des produits de santé (ANSM - AAP-2012-011, Reference 2012S055); the “Agence Nationale de la Recherche” (ANR), reference ANR-12-JSV1-0012-01 and the Association “Les Amis de Rémi,” Savigneux, France. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.