Current options for transfusion-related acute lung injury risk mitigation in platelet transfusions

The approach to transfusion-related acute lung injury (TRALI) risk mitigation in the United States has evolved over the past decade. Currently, AABB Standards require that all plasma and whole blood for direct transfusion must be collected from men, women who have not been pregnant, or women who have tested negative for human leukocyte antigen antibodies since their most recent pregnancy. These requirements must be expanded to include apheresis platelets by October 2016.The current review briefly summarizes current understanding of the pathogenesis, diagnosis and treatment of TRALI, reviews ongoing efforts to mitigate TRALI risk specifically for platelets in the United States, and explores additional options that may further reduce risk.

Current data indicate that TRALI mitigation efforts have been successful at reducing risk from plasma. This implies that expansion of the requirements to include apheresis platelets should further decrease TRALI risk. Additional options currently available for apheresis platelets include plasma replacement with platelet additive solution, washing, and volume reduction. However, there are insufficient data to support the adoption of any of these strategies once existing TRALI mitigation strategies are fully implemented.

Substantial progress has been made in reducing risk for antibody-mediated TRALI in plasma. The upcoming expansion of existing strategies for plasma mitigation to include apheresis platelets is expected to further decrease risk.