Breathless

Abstract

After an unrelated donor transplant for acute leukemia, a young man with pulmonary aspergillosis became short of breath forty-five minutes after a transfusion of pooled platelets. He developed profound hypoxemia. A chest X-ray showed bilateral shadowing of the lungs. Transfusion-associated lung injury (TRALI) was suspected, and samples from platelet donors were tested for HLA/HNA antibodies. A female donor in whose plasma the platelet pool was resuspended tested positive for antibodies to the granulocyte antigen HNA-3. Cross-match between the donor’s serum and patient’s granulocytes was positive. The incidence of TRALI has decreased since the introduction of preferential use of male plasma for production of platelets and fresh frozen plasma. Currently, the leading cause of death due to transfusions in the UK is transfusion-associated circulatory overload.