Transfusion-related acute lung injury associated with interdonor incompatibility for the neutrophil-specific antigen HNA-1a

Background and Objectives: A patient transfused with two pooled platelet co ncentrates became breathless. Bilateral infiltrates were seen on chest X-ra y. A diagnosis of transfusion-related acute lung injury (TRALI) was made. T he patient received 100% oxygen and recovered after 5 days. Materials and M ethods: Antibody screening, cross-matching for granulocyte and lymphocyte a ntibodies and typing for granulocyte antigens was undertaken. Results: The patient typed as HNA-1b/HNA-1b. Granulocyte and lymphocyte antibodies were not detected in the patient's serum or in any of the donor sera by cross-ma tch. In antibody screening against typed panel granulocytes, complement-fix ing anti-HNA-1a IgM antibodies were detected in the serum of one female don or. Two of the other donors who contributed to the pooled platelet concentr ate containing the HNA-1a IgM antibodies typed as HNA-1a/HNA-1b. Conclusion : Anti-HNA-1a IgM antibodies may have formed immune complexes with white ce ll fragments or soluble Fc gamma RIII from HNA-1a+ donors in the pooled pla telet concentrate and initiated TRALI. Copyright (C) 2000 S. Karger AG, Bas el.