TRANSFUSION-RELATED ADULT-RESPIRATORY-DISTRESS-SYNDROME

Leukocyte antibodies are the major cause of nonhemolytic transfusion r eactions. One of the less frequent but severe forms of this reaction i s the adult respiratory distress syndrome, or transfusion-related acut e lung injury. This rare phenomenon is the result of leukocyte antibod ies forming immune complexes with granulocytes, complement activation, sequestration of activated granulocytes in the pulmonary capillary be d, and their degranulation associated with release of proteolytic and cytotoxic substances. This cascade causes endothelial damage with incr eased capillary permeability. Plasma fluids and proteins accumulate in the interstitial and intra-alveolar spaces, leading to respiratory in sufficiency. We present two patients with transfusion-related adult re spiratory distress syndrome associated with leukocyte HLA antibodies, who were successfully treated in our hospital. The pathogenesis, diagn ostic measures and treatment of this uncommon yet critical condition i s discussed.