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Prepublished online as a Blood First Edition Paper on September 5, 2002; DOI 10.1182/blood-2002-03-0958. This Article Full Text (PDF) All Versions of this Article: 2002-03-0958v1 101/2/454    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Silliman, C. C Articles by Ambruso, D. R Search for Related Content PubMed PubMed Citation Articles by Silliman, C. C Articles by Ambruso, D. R Social Bookmarking                   What's this? Submitted March 27, 2002 Accepted August 23, 2002 Transfusion-related acute lung injury: epidemiology and a prospective analysis of etiologic factors Christopher C Silliman, Lynn K Boshkov*, Zahra Mehdizadehkashi, David J Elzi, William O Dickey, Linda Podlosky, Gwen Clarke, and Daniel R Ambruso Department of Research, Bonfils Blood Center, Denver, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, USA; Department of Surgery, University of Colorado School of Medicine, Denver, CO, USA Department of Pathology, Oregon Health Sciences University, Portland, OR, USA The American Red Cross, Portland, OR, USA Department of Research, Bonfils Blood Center, Denver, CO, USA Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada Department of Research, Bonfils Blood Center, Denver, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, USA * Corresponding author; email: boshkovl{at}ohsu.edu. Transfusion-related acute lung injury (TRALI) is a life threatening complication of hemotherapy. We report a series of 90 TRALI reactions in 81 patients secondary to transfusion with whole blood platelets (72), apheresis platelets (2), packed red cells (15) and plasma (1). The overall prevalence was 1/1,120 cellular components. To examine the epidemiology of TRALI we completed a nested case control study of the first 46 patients with TRALI compared to 225 transfused controls. We then completed a prospective analysis possible biologic response modifiers responsible for 51 of the TRALI cases, including HLA Class I, Class II, and granulocyte antibodies in donors, and neutrophil (PMN) priming activity in the plasma of the implicated units and recipients. Two groups were at risk: patients with hematologic malignancies (p<0.0004) and patients with cardiac disease (p<0.0006), and TRALI was associated with older platelets (p=0.014). In the prospective study, anti-leukocyte antibodies were found in only 3.6% of cases. The implicated blood components had greater PMN priming activity than controls (p<0.05), and as compared to pre-transfusion, TRALI patients' plasma demonstrated increases in both IL-6 and lipid priming activity, consisting of neutral lipids and lysophosphatidylcholines (p<0.05). We conclude that TRALI may be more frequent than previously recognized, and patient susceptibility, product age, and increased levels of bioactive lipids in components may predispose patients to TRALI. TRALI, like the acute respiratory distress syndrome may be a two-event phenomenon with both recipient predisposition and factors in the stored units playing major roles. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: C. Koch, L. Li, P. Figueroa, T. Mihaljevic, L. Svensson, and E. H. 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