If both Febrile nonhemolytic transfusion rxn and TRALI are both caused by anti-leukocyte ABs, what determines which will develop in the patient?
TRALI has been associated with HLA or granulocyte antibodies in the donor plasma. Lipid inflammatory mediators may also play a role. All of this requires a donor/recipient interaction, ie a fit for the molecular process to result in TRALI. Multiparous females are more likely the cause and at least one blood center in the USA is now excluding females as plasma donors. (It is not possible to remove the donor antibodies after collection and no way to prevent TRALI if this molecular interaction goes forward.) FNHTR (febrile non-hemolytic transfusion reactions) may be associated with recipient antibodies against donor leukocytes or pyrogenic cytokines in the transfused unit. The risk of these reactions may be minimized by leukoreduction of the blood component or premedication of the recipient with acetaminophen. FNHTRs occur more frequently than TRALI, but apparently, TRALI has been previously underrecognized and underreported.
