TRANSFUSION PRACTICE Storage time of blood products and transfusion-related acute lung injury Rutger A. Middelburg, Barbara Borkent, Mart Jansen, Leo M.G. van de Watering, Johanna C. Wiersum-Osselton, Martin R. Schipperus, Erik A.M. Beckers, Ernest Briët, and Johanna G. van der Bom BACKGROUND: Besides white blood cell antibodies in plasma-rich products, another cause of transfusion- related acute lung injury (TRALI) could be release of biologically active substances during storage of cellular blood products. We aimed to investigate the association of storage time and risk of TRALI for different product types. STUDY DESIGN AND METHODS: We compared storage time of blood products transfused within 6 hours before the onset of TRALI to storage time of a representative sample of all blood products transfused in the Netherlands. Generalized linear models were used to correct for confounding variables. RESULTS: Platelets (PLTs) in plasma transfused to TRALI patients were stored for 0.7 (95% confidence interval [CI], 0.073 to 1.3) days longer than those trans- fused to controls. The relative risk of TRALI, after receiving PLTs stored for 4 or 5 days, compared to 3 days or less, was 5.8 (95% CI, 0.99 to 110) and increased to 6.3 (95% CI, 1.1 to 118) after more than 5 days (i.e., 6 or 7 days). CONCLUSIONS: While longer storage of buffy coat– derived PLTs was associated with an increased risk of TRALI, storage of plasma for up to 2 years and red blood cells for up to 35 days was not associated with the risk of TRALI. T ransfusion-related acute lung injury (TRALI) has long been the most common serious adverse event of blood transfusions. 1-4 Because TRALI can be caused by white blood cell (WBC) antibodies, which are more common in (parous) female donors, measures have been taken in some countries to exclude these donors from donation of plasma for transfusion. 3,5-8 Since the implementation of male- only or predominantly male plasma for transfusion, the risk of TRALI after transfusion of plasma has decreased substantially. 8,9 However, it is expected, and confirmed by some data, that measures directed at keeping all WBC antibodies out of the blood supply can only prevent between two- and three-fifths of all TRALI. 9,10 Therefore, the search for other risk factors for TRALI continues. Some have suggested substances released during storage of cellular blood products may cause TRALI. 11-13 However, the clinical relevance of normally occurring dif- ferences in storage time of blood products is not well established. Further, attention has been focused mainly on platelets (PLTs), and the effect of storage time of plasma and red blood cells (RBCs) on the risk of TRALI has not From the Department of Clinical Epidemiology, Leiden Univer- sity Medical Center, and Sanquin-LUMC Jon J. van Rood Center for Clinical Transfusion Research, Leiden, The Netherlands; UMC Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands; TRIP (Transfusion Reactions in Patients) Dutch National Hemovigilance Office, The Hague, The Netherlands; and Internal Medicine-Hematology, Maastricht University Medical Center, Maastricht, The Netherlands. Address reprint requests to: Rutger A. Middelburg, Sanquin- LUMC Jon J. van Rood Center for Clinical Transfusion Research, Plesmanlaan 1A, 2333 BZ Leiden, The Netherlands; e-mail: R.Middelburg@Sanquin.nl. This study was funded by the Leiden University Medical Center and Sanquin Blood Supply. Received for publication May 17, 2011; revision received July 18, 2011; and accepted July 25, 2011. doi: 10.1111/j.1537-2995.2011.03352.x TRANSFUSION 2012;52:658-667. 658 TRANSFUSION Volume 52, March 2012