TRALI after the transfusion of cross-match-positive granulocytes

TRALI is a serious complication of transfusion. WBC antibodies have been associated with TRALI. The importance of such antibodies for the transfusion of granulocytes is unknown.

A patient with hematologic malignancy and neutropenia-associated pneumonitis received 2 units of granulocytes despite a positive serologic cross- match. She developed severe TRALI after the second transfusion.

The recipient's serum was reactive with immobilized HLA class I antigens from donor cells in a glycoprotein-specific assay. With an absorption-elution technique, at least anti-HLA-A2 could be identified as one of the donor-reactive antibodies in the recipient's serum.

Granulocyte-reactive antibodies are associated with TRALI in an alloimmunized patient receiving granulocyte transfusions. Performing a cross-match procedure may be helpful in preventing severe pulmonary reactions. Additional data are required to determine whether cross-matching as a regular practice in granulocyte transfusions would be beneficial for patients.