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Non-immune TRALI
Abstract   Peer reviewed

Non-immune TRALI

Yoke Lin Fung, J P Tung, R M Minchinton and J F Fraser
Transfusion Medicine, Vol.5(2), p.57
European Symposium on Platelet and Granulocyte Immunobiology, XII (Warsaw, Poland, 10-May-2012–13-May-2012)
2012
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http://www.jtm.viamedica.pl/View
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Abstract

Clinical Sciences
Background: Reviews of laboratory results from TRALI casesnow confirm that over 20% of TRALI events have no associatedleukocyte antibody, and thus are non-immune TRALI events [1--3]. This form of TRALI is hypothesised to follow the two-event orpriming TRALI mechanism, where non-antibody factors (NAF) ac-tivate the patient's neutrophils (key effector cells) [4] which wereoriginally primed by the patient's underlying clinical condition.Experimental evidence for non-immune TRALI: Sillimanand colleagues were pioneers in demonstrating that lipids in sto-red blood products could prime neutrophils [5]. Recently theyreported that non-polar lipids which accumulate during storageof leukoreduced packed red blood cells (PRBC) may representthe key agents provoking antibody-negative TRALI [6].Animal models have been very useful for dissecting the mecha-nism underlying non-immune TRALI. Ex vivo rat models sho-wed that plasma from aged human platelet and aged human PRBCcould precipitate acute lung injury (ALI) [7, 8]. These findingswere confirmed in a syngeneic in vivo rat model which in addi-tion to ALI provoked coagulopathy [9, 10]. To investigate in de-tail the pathophysiology of non-immune TRALI, we used an invivo ovine model [11]. By comparing the TRALI triggered by aged platelet supernatant versus aged PRBC supernatant in this mo-del we found that PRBC produced more severe symptoms andsigns of TRALI [12].Conclusions: While the use of male predominant plasma richblood components will minimise the incidence of antibody me-diated TRALI, there are currently no consistent strategies inplace to minimise non-immune TRALI. The cumulative eviden-ce from careful laboratory investigation of TRALI cases togetherwith in vitro, ex vivo and in vivo data confirm the existence ofnon-immune TRALI. This knowledge base is also fundamentalto elucidating the mechanisms of transfusion-related immuno-modulation (TRIM). Both lines of investigations provide idealplatforms for developing strategies to make blood transfusionsafer for patients

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