NONCARDIOGENIC PULMONARY-EDEMA AFTER TRANSFUSION OF PLASMA CONTAINING AN ANTI-HLA-B21 ANTIBODY

A patient with a von Willebrand factor deficiency received three units of fresh frozen plasma during a postoperative period. During the last unit transfusion she developped a severe respiratory distress and non cardiac pulmonary edema was diagnosed based upon the clinical, radiological and hemodynamic findings. Reintubation and mechanical ventilation with end-expiratory pressure were instituted leading to a copmplete and rapid recovery within 48 h. The serum from the last plasma donor contains an anti-HLA-B21 lymphocytotoxic antibody that did agglutinate neutrophils from HLA-B21 positive individuals. The patient's HLA type was B21. The concerned donor was a IVpare Igeste female. Two problems are evoked by this observation with regard to transfusion : first, fresh-frozen plasma was used as an unappropriate treatment for a coagulating factor deficiency, second, exclusion of this donor from a classical blood donation is needed.