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Blood Center/Blood Hospital-Based Donor Center

(P-BC-4) Incidence of TRALI among recipients of platelet transfusions: report from a national hemovigilance program 2006-2023. 

Sunday, October 20, 2024
12:00 PM - 1:00 PM  

    Presenting Author(s)

  • EG

    Eric Gehrie, MD

    Executive Physician Director, Therapeutic & Cellular Solutions
    American Red Cross
    Baltimore, Maryland, United States

Background/Case Studies: Over the past 20 years, TRALI incidence has declined. This is mainly attributed to TRALI risk mitigation strategies focusing on plasma donors. Recently, fewer platelets collected in 100% plasma (Plasma PLT) and whole blood derived pooled platelets (Pool PLT) have been manufactured in favor of more platelet additive solution-C/Intersol (PAS PLT) and pathogen reduced platelets collected in PAS-C (PAS-PR PLT). We sought to determine whether platelet type influenced TRALI reports to our hemovigilance program. 

Study

Design/Methods: From 2006-2023, our blood center distributed 11,672,537 Plasma PLTs, 1,502,332 PAS PLTs, 2,911,297 PAS-PR PLTs and 538,467 Pool PLTs. We aggregated reports (2006-2023) of TRALI made to our blood center’s hemovigilance program that were assessed to have a high probability of being related to a platelet transfusion by one of our medical directors. Incidence of TRALI for each type of platelet (Plasma, Pool, PAS and PAS-PR) was calculated. Two outliers were excluded from further analysis (Pool PLT in 2016 and PAS PLT in 2013). Then, a linear mixed model regression analysis with repeated measures was performed with platelet type as the fixed effect, and year as the random effect. 

Results/Findings: The overall incidence of TRALI was highest for Pool PLT, followed by Plasma PLT, PAS PLT, and PAS-PR PLT (Table 1). Our blood center stopped manufacturing Pool PLT in 2020. The mean difference in TRALI rates for Plasma PLT compared to the combination of PAS PLT and PAS-PR PLT was statistically significant (p< 0.05). In addition, the differences between Plasma PLT vs. PAS PLT and Plasma PLT vs. PAS-PR PLT were also significant (p< 0.05). However, the difference between PAS PLT and PAS-PR PLT was not significant (p=0.996). 

Conclusions: While high probability TRALI reports are relatively rare overall, platelet formulations that include a larger amount of plasma are associated with more reported cases of TRALI. A recent report suggested a lower risk of pulmonary complications among recipients of PR PLTs (collected in plasma or PAS) vs non-PR PLT (collected in either plasma or PAS). It is believed that this may be due to the elimination- via pathogen reduction - of small numbers of bacteria that could potentially mediate a pulmonary injury in susceptible recipients. While a trend favoring PAS-PR PLTs compared to PAS P</span>latelets was discernable in our analysis, the difference was not statistically significant for the years studied.