Blood Collection Changes Announced

New Measures to Reduce Incidence of Transfusion-Related Acute Lung Injury

To reduce the incidence of transfusion-related acute lung injury (TRALI) nationwide, the American Red Cross has decided to preferentially distribute plasma from male donors. In addition, Cedars-Sinai will no longer accept plasma donations from women who have been pregnant.

"There is a strong female predominance of donors implicated in cases of TRALI, due to the fact that pregnancy is known to lead to alloimmunization to white cell antigens," said Ellen B. Klapper, M.D., co-medical director of the Division of Transfusion Medicine. "Data from the United Kingdom demonstrate a significant reduction in the incidence of TRALI since the elimination of female-derived plasma from their inventory."

In order to prevent a plasma shortage, the Red Cross will simultaneously increase its supply of plasma frozen within 24 hours of collection, and the vast majority of these units will be prepared from their male donors. Fresh frozen plasma is defined as plasma frozen within eight hours of collection, and the difference between these two plasma components is not considered to be clinically significant, said Klapper.

"Several studies have shown them to have similar clotting factor profiles, and many hospitals around the country already use them interchangeably," she said.

"The utilization of plasma increases each year at Cedars-Sinai, and to reduce the risk of TRALI and maintain an adequate supply, we plan to substitute plasma frozen within 24 hours for fresh frozen plasma," Klapper added.

TRALI is the leading cause of transfusion-related fatality reported to the FDA. TRALI is considered to result from the transfusion of white cell directed antibodies present in donor plasma that react with circulating white blood cells in transfusion recipients. This immunologic interaction leads to the development of pulmonary edema and hypoxemia following the elaboration of cytokines that damage the pulmonary microvasculature.

For more information, please contact Ellen Klapper at ellen.klapper@cshs.org.