Prevention Strategies:
1. The best way to prevent TRALI is by limiting the amount of transfused products and rethinking the need for and efficacy thereof of transfusion.
Triggers for transfusion of blood and blood products should be raised. SHOT strongly advises against unnecessary blood product transfusion.
2. Screening blood products for white cell antibodies.
The prevalence of HLA antibodies in the donor pool ranges from 8% to 22%, but the prevalence of neutrophil-specific antibodies is not known. If these antibodies are found in the donor, it is still debated whether these donors should be deferred from donation, their blood should only be used for low plasma volume products, or no intervention taken.
3. Debate on the prevention of TRALI often centers on the female donor, especially the multiparous donor. Parity is especially associated with increased antibody prevalence, and the majority of donors associated with TRALI are multiparous
females.
In late 2006, the American Association of Blood Banks (AABB),made several recommendations to reduce the frequency
of TRALI, including moving toward the use of high plasma volume containing products that are donated only by men.
4. Leukoreduction; it is currently employed by several Western countries. However, the various methods of leukoreduction have drawbacks. For example, although washing may also reduce biologically active substances, it decreases blood product quantity and shelf-life.
5. As aging RBCs accumulate both lipid mediators and leukocyte-derived substances, an argument can also be made for using fresher RBCs, when possible, to minimize the immune consequences of transfusion.
6. Finally, with regards to the management of a donor involved in a TRALI reaction, the AABB provides a series of guidelines, including deferring the donor from all donations, deferral of donation from high plasma volume containing products only, washing donor RBCs, and plasma fractionation.
Ref : Journal of Intensive Care Medicine / Vol. 23, No. 2, March/April 2008
Click here to read about 'Definition' of TRALI
Click here to read about Pathophysiology of TRALI
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