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Transfusion‐Related Acute Lung Injury Associated with Interdonor Incompatibility for the Neutrophil‐Specific Antigen HNA‐1a

Background and Objectives: A patient transfused with two pooled platelet concentrates became breathless. Bilateral infiltrates were seen on chest X‐ray. A diagnosis of transfusion‐related acute lung injury (TRALI) was made. The patient received 100% oxygen and recovered after 5 days. Materials and Methods: Antibody screening, cross‐matching for granulocyte and lymphocyte antibodies and typing for granulocyte antigens was undertaken. Results: The patient typed as HNA‐1b/HNA‐1b. Granulocyte and lymphocyte antibodies were not detected in the patient's serum or in any of the donor sera by cross‐match. In antibody screening against typed panel granulocytes, complement‐fixing anti‐HNA‐1a IgM antibodies were detected in the serum of one femaledonor. Two of the other donors who contributed to the pooled platelet concentrate containing the HNA‐1a IgM antibodies typed as HNA‐1a/HNA‐1b. Conclusion: Anti HNA‐1a IgM antibodies may have formed immune complexes with white cell fragments or soluble FcγRIII from HNA‐1a+ donors in the pooled platelet concentrate and initiated TRALI.