Vox Sanguinis (2016) © 2016 International Society of Blood Transfusion DOI: 10.1111/vox.12383
Underdiagnosing of antibody-mediated transfusion-related acute lung injury: evaluation of cellular-based versus bead-based techniques D. van Stein,1 E. A. M. Beckers,2 A. L. Peters,3 L. Porcelijn,4 R. A. Middelburg,5,6 N. M. Lardy,4 D. J. van Rhenen7 & A. P. J. Vlaar3 1
Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands Department of Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, The Netherlands 3 Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands 4 Sanquin Diagnostics, Sanquin Blood Bank, Amsterdam The Netherlands 5 Center for clinical transfusion research, Sanquin Research, Leiden, The Netherlands 6 Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands 7 South West Region, Sanquin Blood Bank, Rotterdam, The Netherlands 2
Background and objectives Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. To support the diagnosis of antibody-mediated TRALI, HLA and HNA antibodies are tested in involved blood donors. Identification of antibody positive donors is important as exclusion of these donors is part of preventative strategies against TRALI. We compared cellular-based versus bead-based techniques for diagnosis of antibody-mediated TRALI. Materials and methods All reported TRALI cases in the Netherlands during a 5year period were evaluated. Donors were screened for the presence of HLA class I and class II antibodies using both cellular-based and bead-based techniques. Results In total, 100 TRALI cases were reported of which 91 were fully tested. In 113 donors, HLA antibodies were detected of which 84 were only detected by bead-based techniques, 12 only by cellular-based tests and 17 by both assays. Antibody-mediated TRALI was diagnosed in 44 of 91 reported cases. Twenty-one (48%) of these cases would not have been identified using only cellular-based assays.
Received: 18 October 2015, revised 3 January 2016, accepted 4 January 2016
Conclusion Bead-based techniques show a higher sensitivity for detecting incompatible donors in TRALI cases than cellular-based assays. These results suggest that the use of bead-based assays will result in a significant reduction of future TRALI reactions as more antibody positive donors will be excluded from future donations. Key words: bead-based assays, cellular-based assays, diagnosis, HLA antibodies, transfusion-related acute lung injury.
Introduction Transfusion-related acute lung injury (TRALI) is a serious, sometimes fatal complication of blood transfusion. It is Correspondence: Alexander P.J. Vlaar, Department of Intensive Care Medicine, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands E-mail: [email protected]
the leading cause of transfusion-related morbidity and mortality according to the FDA, although in the latest reports of the Dutch and United Kingdom’s haemovigilance office, it has been overtaken by transfusion associated circulatory overload [1–3]. TRALI is defined according to the Canadian Consensus Conference (CCC) criteria (Table 1) as the acute onset of hypoxaemia (paO2/ FiO2 ≤300 mmHg or saturation