Mens Plasma Is From Mars

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  • After the mainstream media caught wind of the AABB bulletin suggesting that male plasma would be preferred for transfusion, they responded in an additional bulletin to clarify their original statement. They in no way intended to insinuate that female plasma was in some way “inferior”, and that future studies would need to be pursued…
  • In practice this is only partially true.
  • One of the most concerning reactions as a result of the presence of antibody in donor platelets is TRALI (transfusion related actue lung injury)
  • ***some cases up to 24 hrs.
  • Which may be synergistic, actually
  • *One study linked TRALIs to recipient antibodies in up to 6% of cases.
    **or direct activation
  • But also heme malignancy after heart surgery??
  • But this is low compared to ARDS which is reported in the 40 to 50 range!
  • Mens Plasma Is From Mars

    1. 1.  The plasma of multiparous women is expected to possess more antibodies, on average, than men due to the increased exposure to additional antigens during childbirth.  Therefore, plasma donated by females is more likely to cause immune-mediated transfusion reactions.
    2. 2.  Purpose: › evaluate the relationship between donor/recipient Ab’s and ANHTR’s.  M&M: › 223 ANHTR pts and 196 of their donors › screened for antibodies to HLA Classes I & II as well as granulocytes and platelets.  Results: › No difference in the types and severity of ANHTR’s. › Frequency of only anti-HLA Ab’s was higher in females. › Non-HLA Ab’s were associated with more severe reactions.  Discussion: › 5 TRALI’s were observed  All 5 had concomitant lung disease.  The 5 patients had received blood from 2 male donors with anti- granulocyte antibodies!
    3. 3.  First described in 1985, Transfusion- Related Acute Lung Injury has since become the most common serious transfusion reaction in the United States.  It’s estimated to occur in 1 in 5000 transfused units.
    4. 4.  TRALI is characterized by the acute (less than 6 hrs*) onset of bilateral non- cardiogenic pulmonary edema/respiratory failure with resultant hypoxemia after blood/blood product transfusion.  Fever, tachycardia, hypotension, cyanosis and characteristic CXR findings are common as well.
    5. 5.  Currently there are two proposed mechanisms: 1. Immune-Mediated 2. Non-Immune-Mediated
    6. 6.  As blood products are stored, degradation occurs.  Degradation results in the accumulation of free lipids/lipopolysaccharides.  Infusion of these products has been shown to activate neutrophils adherent to lung vasculature and cause the same end result as immune-mediated TRALI’s.
    7. 7.  Currently, the thought is that the two processes are not mutually exclusive, and may, in fact, work synergistically.  It is also of note, that recent studies have also determined that previous injury, particularly lung injury, is highly correlated with TRALI occurrence.
    8. 8. http://www.mayoclinicproceedings.com/inside.asp?AID=936&UID=
    9. 9. http://www.frca.co.uk/article.aspx?articleid=100902
    10. 10.  Supportive.  Mild TRALI cases may be treated with O2 via NC alone.  More serious cases may require intubation and mechanical ventillation.  Treat hypotension with pressors.  Avoid diuretic administration.  STX and surfactant have not been found to be beneficial.
    11. 11.  Prognosis is much better than ARDS.  Within 96 hours most patients show clinical improvement was well as resolution of infiltrates on CXR.  A minority of patients may experience persistent hypoxemia for up to 7 days.  Approximately 5-10% of reported TRALI’s are fatal.
    12. 12.  We had a reported TRALI event: › Hx: 68 year-old female with severe pancytopenia secondary to MDS was admitted to AMC for chemo/line placement. Pt was given platelets prior to procedure and within 15 minutes, the pt developed severe dyspnea and hypoxia. The transfusion was immediately discontinued and an ABG and CXR were ordered.
    13. 13.  ABG showed severely decrease PO2.  CXR was read as negative.  Culture of platelet bag grew gram positive rods (PCR: staphylococcus epidermis).
    14. 14.  Observation and supportive care with oxygen supplementation.  Despite the bacterial contamination of the unit, the patient’s symptoms were deemed more compatible with TRALI than sepsis.  Case report submitted to the Red Cross.
    15. 15.  While TRALI is not fully understood at this point, it is extremely important for clinicians to be aware of it’s presentation as it has become the most common serious transfusion reaction in the United States.  In an effort to reduce the probability of having a ANFHTR, it has been postulated that using male-only plasma may reduce such a risk.  However, more recent studies have shown that this may, in fact, not be true.
    16. 16.  There is still no diagnostic test to diagnose TRALI.  Some suggested methods of reducing TRALI incidence include: › Filtration/leukoreduction of all blood products. › Reduced storage time of products  PRBC’s to less than 14 days.  PLT’s to less than 2 days.  The key is surveillance and awareness.
    17. 17. Anderson, B. Ban on female plasma donors possible: Valley joins nation in reaction to study on plasma risk. Fresno Bee. December 29, 2006. Associated Press. Blood blanks may soon only take male plasma. January 22, 2007. Berry, I. Blood bank to change plasma policy. Chattanooga Times. January 24, 2007. Fabron A, Lopes L, Brodin J. Transfusion-related actue lung injury. J Bras Pneumol. 2007. Gajic O, Moore B. Transfusion-Related Acute Lung Injury. May Clinic Proc. June 2005. Imoto S, Araki N, Shimada E, Nishimura K, Nose, Y, Bouike Y, Hasimoto M, Mito H, Okazaki H. Comparison of acute non-hemolytic transfusion reactions in female and male patients receiving female or male blood components. Transfusion Medicine. September 2006.

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