A randomized controlled trial of transfusion-related acute lung injury: isplasma from multiparous blood donors dangerous?

BACKGROUND: Transfusion-related acute lung injury (TRALI) and other posttra nsfusion reactions may be caused by granulocyte and/or HLA antibodies, whic h are often present in blood from multiparous donors. The purpose of this s tudy was to compare the effects of plasma from multiparous donors with thos e of plasma from donors with no history of transfusion or pregnancy (contro l plasma) in a prospective, randomized, double-blind, crossover study. STUDY DESIGN AND METHODS: Intensive care patients, judged to need at least 2 units of plasma, were randomly assigned to receive a unit of control plas ma and, 4 hours later, a plasma unit from a multiparous donor (greater than or equal to3 live births) or to receive the plasma units in opposite order . The patients were closely monitored, and body temperature, blood pressure , and heart rate were recorded. Blood samples for analysis of blood gases, TNF alpha, IL-1 receptor antagonist, soluble E selectin, and C3d complement factor were collected at least on four occasions (before and after the tra nsfusion of each unit). RESULTS: Transfusion of plasma from multiparous donors was associated with significantly lower oxygen saturation and higher TNF alpha concentrations t han transfusion of control plasma. The mean arterial pressure increased sig nificantly after the transfusion of control plasma, whereas plasma from mul tiparous donors had no effect on it. Five posttransfusion reactions were ob served in 100 patients, in four cases after the transfusion of plasma from multiparous donors. CONCLUSION: Plasma from multiparous blood donors may impair pulmonary funct ion in intensive care unit patients.