AABB survey of transfusion-related acute lung injury policies and practices in the United States

BACKGROUND: Policies and practices with regard to transfusion-related acute lung injury (TRALI) diagnosis, laboratory investigation of TRALI cases, and donor deferral and donor management are not standardized. STUDY DESIGN AND METHODS: A Web-based survey was designed and administered to participating AABB member institutions in July 2006. RESULTS: The survey response rate was highest for donor centers, followed by larger hospital blood banks and transfusion services. Laboratory case workups regularly included HLA Class I and II antibody testing of donors followed less frequently by HNA antibody testing; recipient specimens for leukocyte antigen typing were usually not obtained, even if indicated as part of the planned workup. Several different criteria (i.e., all donors, female donors only, case by case determination) were used to select which donors should be tested. There was agreement that donors should be deferred if implicated in a TRALI case (i.e., antibody-cognate antigen match); however, donor management policies varied in other scenarios. The final diagnosis of TRALI was often (45%-66% depending on institutional type) based on a combination of clinical and serologic findings rather than on adherence to the clinical definition recommended by the Canadian, Consensus Conference. Many TRALI policies appeared to be decided on a case-by-case basis at the discretion of the institution's medical director. CONCLUSIONS: There is wide variability in procedures and policies related to the diagnosis of and donor investigation and/or management of TRALI cases. Lack of a consensus approach may partly reflect limitations in understanding of TRALI pathogenesis. The survey suggests that increased education of transfusion medicine practitioners is needed.