Transfusion-related acute lung injury associated with interdonor incompatibility for the neutrophil-specific antigen HNA-1a

Background and Objectives: A patient transfused with two pooled platelet concentrates became breathless. Bilateral infiltrates were seen on chest X-ray. A diagnosis of transfusion-related acute lung injury (TRALI) was made. The patient received 100% oxygen and recovered after 5 days. Materials and Methods: Antibody screening, cross-matching for granulocyte and lymphocyte antibodies and typing for granulocyte antigens was undertaken. Results: The patient typed as HNA-1b/HNA-1b. Granulocyte and lymphocyte antibodies were not detected in the patient's serum or in any of the donor sera by cross-match. In antibody screening against typed panel granulocytes, complement-fixing anti-HNA-1a IgM antibodies were detected in the serum of one female donor. Two of the other donors who contributed to the pooled platelet concentrate containing the HNA-1a IgM antibodies typed as HNA-1a/HNA-1b. Conclusion: Anti-HNA-1a IgM antibodies may have formed immune complexes with white cell fragments or soluble Fc gamma RIII from HNA-1a+ donors in the pooled platelet concentrate and initiated TRALI. Copyright (C) 2000 S. Karger AG, Basel.