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Blood, 26 February 2009, Vol. 113, No. 9, pp. 2079-2087.
Prepublished online as a Blood First Edition Paper on January 8, 2009; DOI 10.1182/blood-2008-09-177857.
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Submitted September 8, 2008
Accepted December 15, 2008
Plasma from stored packed red blood cells and MHC class I antibodies cause acute lung injury in a two-event in vivo rat model
Marguerite R. Kelher, Tomhiko Masuno, Ernest E. Moore, Sagar Damle, Xianzhong Meng, Yong Song, Xiayuan Liang, Jerry Niedzinski, Steven S. Geier, Samina Y. Khan, Fabia Gamboni-Robertson, and Christopher C. Silliman*
Bonfils Blood Center, Denver, CO, United States
Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
Department of Surgery, School of Medicine, University of Colorado Denver, Aurora, CO, United States
Department of Surgery, Denver Health Medical Center, Denver, CO, United States
Department of Pathology, The Children's Hospital, Aurora, CO, United States
Human Tissue Typing Laboratory, LABS, Centennial, CO, United States
Department of Pediatrics, School of Medicine, University of Colorado Denver, Aurora, CO, United States
* Corresponding author; email: christopher.silliman{at}uchsc.edu.
Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion death. We hypothesize that TRALI requires two events: 1) the clinical condition of the patient and 2) the infusion of antibodies against MHC class I antigens or the plasma from stored blood. A two-event rat model was developed with saline (NS) or endotoxin (LPS) as the first event and the infusion of plasma from packed red blood cells (PRBCs) or antibodies (OX18 and OX27) against MHC class I antigens as the second event. ALI was determined by Evans blue dye leak from the plasma to the bronchoalveolar lavage fluid (BALF), protein and CINC-1 concentrations in the BALF, and the lung histology. NS-treated rats did not evidence ALI with any second events, and LPS did not cause ALI. LPS-treated animals demonstrated ALI in response to plasma from stored PRBCs, both pre-storage leukoreduced and unmodified, and to OX18 and OX27, all in a concentration-dependent fashion. ALI was neutrophil (PMN)-dependent, and OX18/OX27 localized to the PMN surface in vivo and primed the oxidase of rat PMNs. We conclude that TRALI is the result of two events with the second events consisting of the plasma from stored blood and antibodies that prime PMNs.
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