Implementing Donor HLA Antibody Testing to Reduce the Number of Transfusion-Related Acute Lung Injuries

Background: Transfusion-related acute lung injury (TRALI) is a major cause of morbidity and mortality. The impact of HLA antibody testing on female plateletpheresis donors with four or more pregnancies was evaluated to determine if there was a reduced incidence of TRALI reported. Methods: During a 12-month period, pregnancy histories were obtained from female plateletpheresis donors. If the donor reported four or more pregnancies, HLA antibody testing was performed. The percentage of TRALI cases reported per number of female plateletpheresis donors was then compared to the previous 12-months prior to HLA antibody testing. Results: During the study and control periods, there were 10,669 and 10,851 female plateletpheresis donors, respectively. HLA antibody screening was performed on 297 female donors (2.78%) meeting criteria; 62 tested positive (20.9%). During the study period, 27 TRALI reactions were reported. Five implicated donors (18.5%) had HLA antibodies. During the control period, 8 TRALI reactions were reported; one donor (12.5%) had HLA antibodies. Conclusion: Implementing HLA antibody testing on female plateletpheresis donors with four or more pregnancies had no overall effect on the incidence of reported TRALI reactions. Further studies are needed to determine the operational/financial impact of screening all multiparous females for HLA antibodies to prevent TRALI.