| Testing only donors with a prior history of pregnancy or transfusion is a logical and cost-effective transfusion-related acute lung injury prevention strategy. | |
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MedLine Citation:
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PMID: 18717778 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related fatality reported to the Food and Drug Administration. Donor screening may reduce TRALI risk. This study sought to compare the efficacy and safety of different TRALI risk-reduction strategies at a hospital-based donor center. STUDY DESIGN AND METHODS: Samples from 1053 donors who answered questions regarding pregnancy and transfusion history were tested for HLA Class I and II antibodies using a flow cytometry-based screening assay. Donor history was compared with the presence of HLA alloantibodies. These data were used to model several TRALI risk-reduction strategies. The medical records of patients transfused fresh-frozen plasma (FFP) from highly alloimmunized donors were retrospectively reviewed for TRALI. RESULTS: HLA alloimmunization was observed among 25.4 percent (256/1009) of all female donors and among 12.0 percent (3/25) of those male donors who gave a history of prior transfusion. Prior pregnancy, reported by 52.6 percent (531/1009) of females, correlated significantly with HLA alloimmunization (p < 0.0001). The rate of HLA alloimmunization increased with parity. A positive pregnancy history was a sensitive (87.9%) screen for HLA alloimmunization with a negative predictive value of 93.5 percent (95% confidence interval, 91.3%-95.7%). Although 5.9 percent (27/459) of nulliparous, untransfused females demonstrated a positive screening test, only 1 percent (7/459) had a confirmed HLA alloantibody. Transfusion of FFP from donors found retrospectively to be highly alloimmunized led to reactions suggestive of TRALI in 2 of 26 recipients. CONCLUSIONS: Donor history is a reliable predictor of HLA alloimmunization. Testing only donors with a prior history of pregnancy or transfusion is a logical and cost-effective TRALI prevention strategy. |
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Authors:
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Amy Powers; Christopher P Stowell; Walter H Dzik; Susan L Saidman; Hang Lee; Robert S Makar |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2008-08-20 |
Journal Detail:
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Title: Transfusion Volume: 48 ISSN: 1537-2995 ISO Abbreviation: Transfusion Publication Date: 2008 Dec |
Date Detail:
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Created Date: 2008-12-05 Completed Date: 2009-01-02 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0417360 Medline TA: Transfusion Country: United States |
Other Details:
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Languages: eng Pagination: 2549-58 Citation Subset: IM |
Affiliation:
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Blood Transfusion Service, Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Lung Injury
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prevention & control* Antibodies / blood, immunology Blood Donors / statistics & numerical data* Blood Transfusion / economics*, statistics & numerical data* Female HLA Antigens / immunology Humans Immunization Male Pregnancy |
| Chemical | |
Reg. No./Substance:
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0/Antibodies; 0/HLA Antigens |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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