The residual risk of transfusion-related acute lung injury at the American Red Cross (2008-2011): limitations of a predominantly male-donor plasma mitigation strategy

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The American Red Cross began preferentially distributing plasma from male donors in 2007 and subsequently observed an 80% decrease in reported cases of transfusion-related acute lung injury (TRALI) after plasma transfusion. Plasma distributions from male donors now exceed 99% for groups A, B, and O, but only approximately 60% for group AB. We evaluated the ongoing risk of TRALI and the ABO blood group of involved plasma donors.

Study Design and Methods

The rate of suspected TRALI per distributed components before (2006) and after (2008-2011) implementing the predominantly male-donor plasma strategy is compared.


The risk of TRALI from the general inventory of distributed plasma decreased significantly from 18.6 cases per million units in 2006 to 4.2 cases per million units in 2008 to 2011 (p < 0.0001). However, the risk from AB plasma did not change (26.3 cases per million units) and was significantly greater than group A, B, and O plasma in 2008 to 2011 (1.8 per million units; odds ratio 14.5; 95% confidence interval, 6.8-30.9). Group AB plasma from female donors with HLA or HNA antibodies accounted for 14 of 28 (50%) of TRALI cases but less than 4% of all plasma units distributed in 2008 to 2011.


The risk of TRALI after plasma transfusion has been markedly reduced for blood groups A, B, and O but not for AB, reflecting continued reliance on group AB plasma from female donors to meet increasing demand.

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