Ten years of TRALI mitigation: measuring our progress

Area of Science:

• Hematology
• Transfusion Medicine
• Critical Care Medicine

Background:

• Transfusion-related acute lung injury (TRALI) is a significant cause of transfusion-associated mortality.
• Despite implemented mitigation strategies, understanding product-specific TRALI rates is crucial for refining prevention efforts.

Purpose of the Study:

• To longitudinally analyze transfusion-related acute lung injury (TRALI) rates over a decade.
• To identify specific blood components associated with higher TRALI incidence.
• To evaluate the impact of implemented mitigation strategies on TRALI rates.

Main Methods:

• Retrospective multicenter study analyzing TRALI reports from 2007 to 2017.
• Data collected from five blood centers across nine US states.
• TRALI rates calculated per 100,000 components distributed, comparing rates by donor sex and product type.

Main Results:

• Overall TRALI rate was 1.04 per 100,000 components, with higher rates for female-donated components (2.25 vs. 1.08).
• TRALI rates significantly declined from 2.88 in 2007 to 0.60 in 2017.
• Post-2014, female-donated plateletpheresis remained associated with a significantly higher TRALI rate (2.98 vs. 0.75).

Conclusions:

• While mitigation strategies have reduced TRALI incidence, a residual risk persists.
• Female-donated plateletpheresis products pose a continued risk for TRALI.
• Utilizing buffy coat pooled platelets in male plasma or platelet additive solution may further mitigate TRALI.