Mechanisms of transfusion-related acute lung injury (TRALI): Anti-leukocyte antibodies

摘要: There is abundant evidence that leukocyte antibodies in blood donor products are somehow involved transfusion-related acute lung injury (TRALI). Human antigen (HLA) class I, HLA II, and neutrophil-specific the plasma of both donors recipients have been implicated pathogenesis TRALI. The case for a relationship between TRALI more compelling if concordance specificity corresponding on cells affected recipient demonstrated. Such antibody-antigen can be investigated by typing cognate antigens or cross-matching against recipient's leukocytes. Two proposed pathophysiologic mechanisms received most attention: antibody hypothesis two-event hypothesis. final common pathway all pathogenic increased pulmonary capillary permeability, which results movement into alveolar space causing edema. A typical serologic workup consists tests I II antibodies. use flow cytometry HLA-coated microbeads recommended detection combination granulocyte agglutination test immunofluorescence Genotyping limited number neutrophil may also helpful establishing concordance.