Transfusion-related acute lung injury surveillance (2003-2005) and the potential impact of the selective use of plasma from male donors in the American Red Cross
Transfusion-related acute lung injury surveillance (2003-2005) and the potential impact of the selective use of plasma from male donors in the American Red Cross
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DOI：
10.1111/j.1537-2995.2007.01102.x
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发表时间：
2007-04-01
期刊：
影响因子：
2.9
通讯作者：
Benjamin, Richard J.
中科院分区：
文献类型：
--
作者：
Eder, Anne F.;Herron, Ross;Benjamin, Richard J.
背景技术背景：分析美国红十字会对输血相关急性肺损伤（TRALI）死亡的监测数据，以评估与来自具有白色血细胞（WBC）抗体的供体的成分的关联，并检查来自男性供体的血浆的选择性输血的潜在影响。确定了2003年至2005年的疑似TRALI报告，所有死亡病例均由三名医生审查并分类为“可能的TRALI”或“病因无关，并对相关血清学调查进行独立审查。医院调查和报告的偏见不能完全控制在这个回顾性研究。结果：共550例疑似TRALI，包括72例死亡的报告进行了调查。报告的数量每年都在增加，而且各地理区域的增长率各不相同。对死亡病例的回顾性审查显示，38例病例可能为TRALI，大多数（24/38 [63%]）发生在血浆输注后。71%（38例中的27例）的病例和75%（24例中的18例）的血浆输注病例涉及女性WBC抗体阳性供体。与无关病例相比，女性抗体阳性供体更可能与可能的TRALI相关（p = 0.0001;比值比[OR]，9.5; 95%置信区间[CI]，2.9-31.11）。与红细胞（1：2，527，437）相比，血浆成分（1：202，673; OR，12.5; 95%CI，5.4-28.9）和单采血小板（PLT; 1：320，572; OR，7.9; 95%CI，2.5-24.8）在受体死亡中的可能TRALI发生率更高。2005年男性献血者的血小板和血浆成分分别占单采血小板和血浆成分的64.5%和52.0%。结论：与WBC抗体相关的女性献血者的血浆成分是导致TRALI死亡的主要原因。采取谨慎措施，限制输注含有白细胞抗体的血浆成分，可以防止红十字系统每年多达6例死亡。
BACKGROUND: American Red Cross surveillance data on transfusion-related acute lung injury (TRALI) fatalities were analyzed to evaluate the association with components from donors with white blood cell (WBC) antibodies and to examine the potential impact of the selective transfusion of plasma from male donors.STUDY DESIGN AND METHODS: Suspected TRALI reports in 2003 through 2005 were identified and all fatalities were reviewed and classified by three physicians as "probable TRALI" or of "unrelated etiology," with independent review of the associated serologic investigation. Hospital investigational and reporting biases could not be fully controlled in this retrospective study.RESULTS: A total of 550 reports of suspected TRALI, including 72 fatalities, were investigated. The number of reports increased each year and the rate varied by geographic region. Retrospective review of fatalities revealed 38 cases of probable TRALI, the majority (24 of 38 [63%]) after plasma transfusion. A female, WBC anti body-positive donor was involved in 71 percent (27 of 38) of cases and in 75 percent (18 of 24) of cases involving plasma transfusion. Female anti body-positive donors were more likely to be associated with probable TRALI than with unrelated cases (p = 0.0001; odds ratio [OR], 9.5; 95% confidence interval [CI], 2.9-31.11. The rate of probable TRALI among recipient fatalities was higher for plasma components (1:202,673; OR, 12.5; 95% CI, 5.4-28.9) and apheresis platelets (PLTs; 1:320,572; OR, 7.9; 95% CI, 2.5-24.8) compared to red cells (1:2,527,437). Male donors contributed 64.5 and 52.0 percent of distributed apheresis PLTs and plasma components, respectively, in 2005.CONCLUSION: Plasma components linked to female donors with WBC antibodies were responsible for the majority of probable TRALI fatalities. Prudent measures to limit transfusion of WBC antibody-containing plasma components may prevent as many as six fatalities per year in the Red Cross system.