HLA antibodies have been implicated in the production of transfusion-related acute lung injury (TRALI). A 35-year-old man with hemorrhagic gastric ulcer was given three units of concentrated red cells (CRC) by transfusion. At the end of the third CRC transfusion, the patient developed dyspnea and shock. PaO2 was 34.1mmHg with oxygen delivered at 3l/min by face mask. Chest X-ray showed diffuse infiltration of both lung fields. The lowest PaO2/FIO2 ratio was 138. TRALI was dramatically improved by high PEEP. Therefore, he could be weaned from the ventilator on the fourth hospital day. Serological studies demonstrated the recipient's HLA type to be A (2, 24), B (52, 61) and Cw (-, -), and serum from one of three donors had a high titer (64 times) of HLA antibodies (B52). Cross match of the donor serum and recipient lymphocytes and platelets yielded the following results; lymphocyte toxicity test (LCT) indicated strong positivity, the mixed passive hemagglutination (MPHA) method was positive and the MPHA method with chloroquine was negative. The donor was a multiparous, having delivered three children. We are convinced that this TRALI was caused by anti-HLA antibody in CRC.
