HLA class II antibodies in transfusion-related acute lung injury

BACKGROUND: Transfusion-related acute lung injury (TRALI) is a serious, som etimes fatal, complication of transfusion. Granulocyte and HLA class I anti bodies present in blood donors have been associated with TRALI. HLA class I I antibodies have recently been described in a few cases of TRALI. STUDY DESIGN AND METHODS: Donors involved in TRALI reactions reported to a blood center over an 18-month period were tested for HLA class I and I I an tibodies as well as granulocyte antibodies, if HLA antibodies were not iden tified. RESULTS: HLA class II antibodies were identified, in at least one donor, in 7 (64%) of 11 cases of TRALI. HLA class I antibodies were identified in co mbination with HLA class I I antibodies in 5 of these 7 cases. HLA class I antibodies were exclusively identified in 2 cases. Granuloctye antibodies w ere identified in 1 case, and no antibodies were identified in another. CONCLUSION: In addition to HLA class I antibodies, HLA class 11 antibodies are associated with TRALI. Testing of donors for HLA class 11 antibodies as well as HLA class I and granulocyte antibodies is recommended as part of t he investigation of suspected cases of TRALI.