TRALI Risk Reduction: Donor and Component Management Strategies
TRALI Risk Reduction: Donor and Component Management Strategies
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DOI：
10.1002/jca.20198
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发表时间：
2009-01-01
影响因子：
1.5
通讯作者：
Benjamin, Richard J.
中科院分区：
文献类型：
--
作者：
Eder, Anne F.;Benjamin, Richard J.
输血相关性肺损伤 (TRALI) 的发生率约为五千分之一，可能会导致临床实践中尚未认识到的明显更高的发病率和死亡率。根据目前对 TRALI 病因学的了解，血液中心已经实施或正在评估各种供体和成分管理策略，以努力降低 TRALI 风险。许多 TRALI 病例可能是由血液成分中的白细胞抗原（HLA 或 HNA）抗体引起的。大约 10% 至 20% 有怀孕史的女性献血者和 1% 至 5% 的男性献血者携带这些抗体。或者，TRALI 可能由其他生物活性脂质或物质介导，这些脂质或物质在储存过程中积累并在输注给易感患者时引起反应。 TRALI 背后的各种供体、成分和患者相关因素之间复杂的相互作用保证了有效的预防不是单一或简单的干预措施，而是需要多方面的方法。也许，最重要的降低风险策略是努力确保适当使用血液制品并消除不必要的输血。然而，与输血实践相比，采血机构对献血者选择和成分管理拥有更直接的控制权。 AABB 提供了一些指导，以推迟参与 TRALI 的供体，并尽量减少从具有抗白细胞抗体或白细胞同种免疫风险增加的供体中制备高血浆成分。血液中心已采取各种方法来降低 TRALI 风险，并将审查当前策略的可能益处和固有局限性。 J.克林。血浆分离术 24:122-129, 2009。(C) 2009 Wiley-Liss, Inc.
Transfusion-related lung injury (TRALI) occurs in similar to 1 in 5,000 transfusions and may cause considerably more morbidity and mortality that is not recognized in clinical practice. Based on the current understanding of the etiology of TRALI, blood centers have implemented or are evaluating various donor and component management strategies in an effort to mitigate the risk of TRALI Many cases of TRALI are likely caused by antibodies to leukocyte antigens (HLA or HNA) in blood components. Approximately 10 to 20% of female blood donors with a history of pregnancy and 1 to 5% of male blood donors harbor these antibodies. Alternatively, TRALI may be mediated by other bioactive lipids or substances that accumulate during storage and cause a reaction when transfused to susceptible patients. The complex interplay among various donor-, component-, and patient-related factors underlying TRALI guarantees that effective prevention will not be a single or simple intervention but rather will require a multifaceted approach. Perhaps, the most important risk reduction strategy is the effort to ensure appropriate use of blood products and eliminate unnecessary transfusions. Blood collection agencies, however, have more proximate control over donor selection and component management than transfusion practice. AABB has provided some guidance on deferring donors implicated in TRALI and minimizing the preparation of high plasma volume components from donors who have anti-leukocyte antibodies or are at increased risk of leukocyte alloimmunization. Blood centers have taken various approaches to mitigate the risk of TRALI, and the possible benefit and the inherent limitations of the current strategies will be reviewed. J. Clin. Apheresis 24:122-129, 2009. (C) 2009 Wiley-Liss, Inc.