Recurrent transfusion-related acute lung injury after fresh frozen plasma in a patient with hereditary factor V deficiency.

To the Editor: Transfusion-related acute lung injury (TRALI) can be a serious complication resulting from the transfusion of plasma that contains antibodies against recipient white blood cells. There have been only four previously reported cases of recurrent TRALI [1–3]. We describe a patient with recurrent TRALI, emphasizing potential strategies to prevent this disease. A 25-year-old man with hereditary factor V deficiency and a baseline FV level of <2% received five units of fresh frozen plasma after a spontaneous axillary hematoma and developed TRALI. The patient recovered fully and was discharged 48 hr later. Five months later, he received two units of plasma after a trauma-induced right foot hematoma and suffered a recurrent episode of TRALI. Donors associated with the initial and recurrent TRALI episodes were tested for anti-HLA class I, anti-HLA class II, and antigranulocyte antibodies. Sera from three female donors from the first transfusion episode and one female donor from the second transfusion episode showed antibodies against HLA class I, class II, or both (Table I). None showed antigranulocyte antibodies. The patient could not be HLA-typed because of relocation. Both TRALI episodes of our patient met American–European Consensus Conference criteria, including a new episode of acute lung injury occurring within 6 hr of transfusion, bilateral pulmonary infiltrates on chest X-ray, and no evidence of an alternative risk factor for acute lung injury nor of circulatory overload [4]. Our patient was in good health, did not have any of the known