TRANSFUSION-RELATED ACUTE LUNG INJURY DUE TO HLA-A2-SPECIFIC ANTIBODIES IN RECIPIENT AND NB1-SPECIFIC ANTIBODIES IN DONOR BLOOD

Transfusion-related acute lung injury (TRALI) is a hazardous but littl e-known complication of blood transfusion, characterized by non-cardio genic lung oedema after blood transfusion, Leucoagglutinating antibodi es in the donor plasma are considered to play a central role in the pa thogenesis of TRALI but no recommended procedure currently exists for their detection, and most of them have not yet been well characterized , Serum samples of two patients who have developed TRALI within 30 min of blood transfusion and the sera of the involved blood donors were i nvestigated for leucocyte antibodies by granulocyte immunofluorescence , granulocyte agglutination and lymphocytotoxicity assays using typed test cells, Suspected specificities of the detected antibodies were co nfirmed by a luminoimmunoblot assay and the antigen capture assay MAIG A. One case was associated with granulocyte agglutinating anti-HLA-A2 antibodies in the recipient's (i.e. patient's) own blood and the other with donor-related non-agglutinating antibodies directed against the granulocyte-specific antigen NB1, Leucocyte incompatibility between do nor and recipient was shown in both cases by crossmatching and typing of the incompatible cells for the appropriate antigen. The results sho w that TRALI is associated not only with donor- but also with recipien t-related leucocyte antibodies. In addition to leucoagglutinating anti bodies, non-agglutinating granulocyte-specific antibodies can be also involved. For immunodiagnosis, sera from both must be investigated by a combination of granulocyte and lymphocyte (HLA) antibody screening t ests and leucocyte incompatibility verified by crossmatching.