TRANSFUSION-RELATED ACUTE LUNG INJURY - D IAGNOSTIC CONFIRMATION BY DEMONSTRATING GRANULOCYTIC ANTIBODIES

In two patients, a 50-year-old woman (case 1) and a 2-year-old girl (c ase 2) acute shortness of breath requiring artificial ventilation deve loped 3-5 hours after infusion of two erythrocyte concentrates in case 1 and unfiltered platelet-enriched plasma (20 ml/kg) in case 2. The c hest radiograph showed diffuse infiltrations in the lungs of both pati ents. After administration of catecholamines and respirator therapy, e xtubation was possible in the first patient after two days, in the sec ond after five days. In neither case had there been any evidence of hy pervolaemia, heart failure or infection to explain the lung findings. However, the serum of case 1 and the serum of the platelet donour had antibodies against granulocytes. The granulocyte-compatibility test (b etween patient serum and donour granulocytes) was positive. This confi rmed the clinical suspicion of transfusion-related acute lung injury ( TRALI). However, demonstration of antibodies was not only important fo r the diagnosis, but made it possible to recognize a blood donour whos e serum contained antibodies against granulocytes which can provoke TR ALI.