Frequency and severity of transfusion-related acute lung injury - German haemovigilance data (2006-2007)
Frequency and severity of transfusion-related acute lung injury - German haemovigilance data (2006-2007)
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DOI：
10.1111/j.1423-0410.2009.01232.x
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发表时间：
2010-01-01
期刊：
影响因子：
2.7
通讯作者：
Funk, M. B.
中科院分区：
文献类型：
--
作者：
Keller-Stanislawski, B.;Reil, A.;Funk, M. B.
目的在一项观察性队列研究（2006-2007）中，paul - ehrlich研究所收集流行病学资料，调查TRALI的发生频率和原因。方法根据欧洲血液警戒网络的诊断标准对TRALI进行诊断。随后进行白细胞抗体（WBC-Ab）抗HLA或人中性粒细胞异体抗原检测。结果共报告187例TRALI病例，可确诊44例，其中抗体介导的TRALI 35例，非免疫介导的TRALI 9例。44例受影响患者中有8例（18%）死亡，其中7例为WBC-Ab阳性血浆供者，1例为红细胞供者。在1名男性和39名女性献血者中发现白细胞抗体。34名女性献血者证实有妊娠史。WBC-Ab阳性供者有4个HLA I类抗体，15个HLA II类抗体，13个HLA I类和II类抗体，1个HNA-2a抗体，7个HNA-3a抗体。与受体抗原匹配的白细胞抗体仅在28名女性献血者中发现；26名造血干细胞献血者，1名血小板献血者，1名红细胞献血者。新鲜冷冻血浆免疫介导TRALI报告频率为1:66 000，红细胞浓缩物为1:286万，血小板浓缩物为1:42万。FFP报告tri相关死亡的频率为1:285 000。血液警戒数据显示，有妊娠史的女性献血者对抗体介导的TRALI的发展具有重要意义。从男性血浆中制造FFP和对女性供体进行白细胞抗体筛查可以作为预防措施。
ObjectiveIn an observational cohort study (2006-2007) the Paul-Ehrlich-Institut collected epidemiological data to investigate the frequency and causes of TRALI.MethodsDiagnosis of TRALI was confirmed according to criteria of the European Haemovigilance Network. Subsequent testing of white blood cell antibodies (WBC-Ab) against HLA or human neutrophil alloantigens was performed.ResultsOf a total of 187 reported TRALI cases, 44 could be confirmed consisting of 35 cases of antibody-mediated TRALI and nine cases of non-immune-mediated TRALI. Eight of 44 affected patients (18%) had a fatal outcome, seven cases with WBC-Ab positive plasma donors and one case with red blood cell donors. WBC antibodies were found in one male and 39 female donors. In 34 female donors, a history of pregnancy was confirmed. WBC-Ab positive donors presented four HLA class I antibodies, 15 HLA class II antibodies, 13 HLA class I and class II antibodies, one HNA-2a, and seven HNA-3a antibodies. WBC antibodies matching with recipient antigens were found exclusively in 28 female donors; 26 FFP donors, one platelet donor and one red blood cell donor. Reporting frequency of immune-mediated TRALI was 1 : 66 000 for fresh frozen plasma, 1 : 2.86 million for red blood cell concentrates and 1 : 420 000 for platelet concentrates. Reporting frequency of TRALI-related fatalities was 1 : 285 000 for FFP.SummaryHaemovigilance data show the significance of female donors with a history of pregnancy for the development of antibody-mediated TRALI. Manufacturing of FFP from male plasma and female donor screening for WBC-Ab could represent preventive measures.