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Transfusion‐related acute lung injury caused by human leucocyte antigen class II antibody

Summary.  Fcγ receptor (FcγR)‐mediated destruction of immunoglobulin‐coated red blood cells (RBCs) is the underlying mechanism of haemolytic disease of the newborn. Human leucocyte antigen (HLA) antibodies in vitro are able to block monocyte FcγRs and prevent phagocytosis. The intention was to demonstrate this effect in vivo upon a volunteer. Plasma containing a non‐cytotoxic HLA‐DR alloantibody was infused into the subject. The FcγR blockade was achieved and persisted for about 2·5 d, but, unexpectedly, a mild transfusion‐related acute lung injury (TRALI) was also caused. Monocytes disappeared completely from the peripheral blood within the first hour after infusion and a mild pulmonary oedema was observed within 3–4 h. The subject recovered within 2 d.