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Acute and transient decrease in neutrophil count in transfusion-related acute lung injury: cases at one hospital
1Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California, USA. mnakagawa@uams.edu
Transfusion
|December 9, 2004
Summary
Transfusion-related acute lung injury (TRALI) may cause a sudden drop in white blood cell (WBC) count. This decrease in neutrophils can occur even with HLA Class II antibodies, suggesting a previously unrecognized TRALI feature.
Area of Science:
- Hematology
- Immunology
- Transfusion Medicine
Background:
- Transfusion-related acute lung injury (TRALI) is a rare but severe complication of blood transfusions.
- TRALI is defined as acute lung injury occurring during or within six hours of a blood transfusion.
Purpose of the Study:
- To investigate a potential underrecognized feature of TRALI.
- To explore the association between TRALI and changes in white blood cell (WBC) counts.
Main Methods:
- Observational study design.
- Case series analysis of TRALI events.
Main Results:
- All three TRALI cases showed an acute, transient decrease in WBC count.
- Donors had HLA antibodies matching recipients; implicated units included platelets and fresh frozen plasma.
- Neutrophil counts dropped significantly (80-90%) in all cases, including those with HLA Class II antibodies.
Conclusions:
- A transient decrease in WBC count may be an underrecognized characteristic of TRALI.
- Neutropenia can occur with HLA Class II antibodies, even though these are primarily on stimulated neutrophils.
- Complete blood count with differential is recommended when TRALI is suspected.