TRANSFUSION PRACTICE Ten years of hemovigilance reports of transfusion-related acute lung injury in the United Kingdom and the impact of preferential use of male donor plasma Catherine E. Chapman, Dorothy Stainsby, Hilary Jones, Elizabeth Love, Edwin Massey, Nay Win, Cristina Navarrete, Geoff Lucas, Neil Soni, Cliff Morgan, Louise Choo, Hannah Cohen, and Lorna M. Williamson on behalf of the Serious Hazards of Transfusion Steering Group BACKGROUND AND METHODS: From 1996 through 2006, 195 cases were reported as transfusion-related acute lung injury (TRALI) to the Serious Hazards of Transfusion scheme and from 1999 onward classified by probability, using clinical features and HLA and/or HNA typing. From late 2003, the National Blood Service provided 80 to 90 percent of fresh-frozen plasma (FFP) and plasma for platelet (PLT) pools from male donors. RESULTS: Forty-nine percent of reports were highly likely/probable TRALI, and 51 percent possible/unlikely. Of 96 investigations, donor antibodies recognizing recipient antigens were found in 73 cases (65%), with HLA Class I in 25 of those (40%), HLA Class II anti- bodies in 38 (62%), and granulocyte antibodies in 12 (17%). A review in 2003 revealed that the TRALI risk/ component was 6.9 times higher for FFP and 8.2 times higher for PLTs than for red blood cells, and that in donors of implicated FFP/PLTs, white blood cell anti- bodies were found 3.6 times more often than by chance (p  0.0001), with all implicated donors being female. Provision of male plasma was associated with a reduc- tion in TRALI reports from 36 in 2003 to 23 in each of 2004 and 2005 and 10 in 2006. Highly likely/probable cases reduced from 23 in 2003 to 10, 6, and 4 in the 3 subsequent years, with cases implicating FFP or PLTs falling from 16 to 9, 3, and 1 respectively. CONCLUSIONS: The risk of highly likely/probable TRALI due to FFP has fallen from 15.5 per million units issued during 1999 through 2004 to 3.2 per million during 2005 through 2006 (p = 0.0079) and from 14.0 per million to 5.8 per million for PLTs. N ow that the risk of transfusion-transmitted viral infection has reached extremely low levels, transfusion-related acute lung injury (TRALI) has emerged as one of the most serious complications of transfusion. In reports to the Food and Drug Administration (FDA), TRALI moved from the third commonest cause of transfusion-related death in 1997 through 2002 to the commonest in 2003. 1 Although single case reports which were probably TRALI have been published since the 1950s, the syndrome was character- ized and named only in the past 2 decades. 2 The accepted features of TRALI are acute dyspnea with hypoxia and new or worsening pulmonary infiltrates arising during or within a few hours of a transfusion of plasma, cellular blood components, or immunoglobulin. 3 Immediate and ABBREVIATIONS: BC(s) = buffy coat(s); CSP = cryosupernatant; NBS = National Blood Service; SHOT = Serious Hazards of Transfusion; SSP(s) = sequence-specific primer(s); TACO = transfusion-associated circulatory overload; TTP = thrombotic thrombocytopenic purpura; vCJD = variant Creutzfeldt-Jakob disease. From the NHS Blood and Transplant, Newcastle, Manchester, Bristol, Tooting, Colindale, and Cambridge; Serious Hazards of Transfusion, Manchester; Chelsea andWestminster NHS Trust, Royal Brompton NHS Trust, Medical Research Council Clinical Trials Unit, and University College London Hospitals NHS Foundation Trust, London; and the Department of Haematol- ogy, University of Cambridge, Cambridge, UK. Address reprint requests to: Dr Catherine Chapman, NHS Blood and Transplant, Holland Drive, Barrack Road, Newcastle Upon Tyne NE2 4NQ, UK; e-mail: catherine.chapman@ nhsbt.nhs.uk. This study was funded by the UK Blood Services. Received for publication February 3, 2008; revision received August 10, 2008; and accepted August 25, 2008. doi: 10.1111/j.1537-2995.2008.01948.x TRANSFUSION 2009;49:440-452. 440 TRANSFUSION Volume 49, March 2009