The effect of previous pregnancy and transfusion on HLA alloimmunization in blood donors

Implications for a transfusion-related acute lung injury risk reduction strategy

Darrell J. Triulzi, Steven Kleinman, Ram M. Kakaiya, Michael P. Busch, Philip J. Norris, Whitney R. Steele, Simone A. Glynn, Christopher D. Hillyer, Patricia Carey, Jerome L. Gottschall, Edward L. Murphy, Jorge A. Rios, Paul Michael Ness, David J. Wright, Danielle Carrick, George B. Schreiber

Research output: Contribution to journalArticle

Abstract

Background: Antibodies to human leukocyte antigens (HLA) in donated blood have been implicated as a cause of transfusion-related acute lung injury (TRALI). A potential measure to reduce the risk of TRALI includes screening plateletpheresis donors for HLA antibodies. The prevalence of HLA antibodies and their relationship to previous transfusion or pregnancy in blood donors was determined. Study design and methods: A total of 8171 volunteer blood donors were prospectively recruited by six US blood centers from December 2006 to May 2007. Donors provided a detailed history of pregnancy and transfusion and a sample for HLA Class I and II antibody testing by multiantigen bead flow analysis. Results: A total of 8171 donors were enrolled; 7920 (96.9%) had valid HLA antibody test results and 7841 (99%) of those had complete pregnancy and transfusion information. The prevalence of any HLA antibody was similar in nontransfused (n = 1138) and transfused (n = 895) men, 1.0% versus 1.7% (p = 0.16). HLA antibodies were detected in 17.3% of all female donors (n = 5834) and in 24.4% of those with a history of previous pregnancy (n = 3992). The prevalence of HLA antibodies increased in women with greater numbers of pregnancy: 1.7% (zero), 11.2% (one), 22.5% (two), 27.5% (three), and 32.2% (four or more pregnancies; p <0.0001). Conclusion: HLA Class I and Class II antibodies are detectable at low prevalence in male donors regardless of transfusion and in female donors without known immunizing events. The prevalence of HLA antibodies increases significantly with more pregnancies. These data will allow blood centers to estimate the impact of HLA antibody testing as a potential TRALI risk reduction measure.

Original languageEnglish (US)
Pages (from-to)1825-1835
Number of pages11
JournalTransfusion
Volume49
Issue number9
DOIs
StatePublished - Sep 2009
Externally publishedYes

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Acute Lung Injury
Risk Reduction Behavior
HLA Antigens
Blood Donors
Pregnancy
Antibodies
Tissue Donors
Reproductive History
Plateletpheresis
Donor Selection
Immunoglobulin Isotypes
Volunteers

ASJC Scopus subject areas

  • Hematology
  • Immunology
  • Immunology and Allergy

Cite this

The effect of previous pregnancy and transfusion on HLA alloimmunization in blood donors : Implications for a transfusion-related acute lung injury risk reduction strategy. / Triulzi, Darrell J.; Kleinman, Steven; Kakaiya, Ram M.; Busch, Michael P.; Norris, Philip J.; Steele, Whitney R.; Glynn, Simone A.; Hillyer, Christopher D.; Carey, Patricia; Gottschall, Jerome L.; Murphy, Edward L.; Rios, Jorge A.; Ness, Paul Michael; Wright, David J.; Carrick, Danielle; Schreiber, George B.

In: Transfusion, Vol. 49, No. 9, 09.2009, p. 1825-1835.

Research output: Contribution to journalArticle

Triulzi, DJ, Kleinman, S, Kakaiya, RM, Busch, MP, Norris, PJ, Steele, WR, Glynn, SA, Hillyer, CD, Carey, P, Gottschall, JL, Murphy, EL, Rios, JA, Ness, PM, Wright, DJ, Carrick, D & Schreiber, GB 2009, 'The effect of previous pregnancy and transfusion on HLA alloimmunization in blood donors: Implications for a transfusion-related acute lung injury risk reduction strategy', Transfusion, vol. 49, no. 9, pp. 1825-1835. https://doi.org/10.1111/j.1537-2995.2009.02206.x
Triulzi, Darrell J. ; Kleinman, Steven ; Kakaiya, Ram M. ; Busch, Michael P. ; Norris, Philip J. ; Steele, Whitney R. ; Glynn, Simone A. ; Hillyer, Christopher D. ; Carey, Patricia ; Gottschall, Jerome L. ; Murphy, Edward L. ; Rios, Jorge A. ; Ness, Paul Michael ; Wright, David J. ; Carrick, Danielle ; Schreiber, George B. / The effect of previous pregnancy and transfusion on HLA alloimmunization in blood donors : Implications for a transfusion-related acute lung injury risk reduction strategy. In: Transfusion. 2009 ; Vol. 49, No. 9. pp. 1825-1835.
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abstract = "Background: Antibodies to human leukocyte antigens (HLA) in donated blood have been implicated as a cause of transfusion-related acute lung injury (TRALI). A potential measure to reduce the risk of TRALI includes screening plateletpheresis donors for HLA antibodies. The prevalence of HLA antibodies and their relationship to previous transfusion or pregnancy in blood donors was determined. Study design and methods: A total of 8171 volunteer blood donors were prospectively recruited by six US blood centers from December 2006 to May 2007. Donors provided a detailed history of pregnancy and transfusion and a sample for HLA Class I and II antibody testing by multiantigen bead flow analysis. Results: A total of 8171 donors were enrolled; 7920 (96.9{\%}) had valid HLA antibody test results and 7841 (99{\%}) of those had complete pregnancy and transfusion information. The prevalence of any HLA antibody was similar in nontransfused (n = 1138) and transfused (n = 895) men, 1.0{\%} versus 1.7{\%} (p = 0.16). HLA antibodies were detected in 17.3{\%} of all female donors (n = 5834) and in 24.4{\%} of those with a history of previous pregnancy (n = 3992). The prevalence of HLA antibodies increased in women with greater numbers of pregnancy: 1.7{\%} (zero), 11.2{\%} (one), 22.5{\%} (two), 27.5{\%} (three), and 32.2{\%} (four or more pregnancies; p <0.0001). Conclusion: HLA Class I and Class II antibodies are detectable at low prevalence in male donors regardless of transfusion and in female donors without known immunizing events. The prevalence of HLA antibodies increases significantly with more pregnancies. These data will allow blood centers to estimate the impact of HLA antibody testing as a potential TRALI risk reduction measure.",
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