TRALI Update

In early 2006, the AABB issued Association Bulletin #06-07 which contained recommendations to mitigate the risk of TRALI to recipients of high plasma-volume components. The AABB recommended a timeline in which donor centers would adopt strategies to reduce the risk of TRALI in certain products. In addition, AABB recommended that blood transfusion facilities should work toward implementing appropriate evidence-based hemotherapy practices in order to minimize unnecessary transfusion and that blood collection and transfusion facilities should monitor the incidence of reported TRALI and TRALI-related mortality. By November 2007, most donor centers implemented various strategies to reduce the risk of TRALI from fresh frozen plasma (FFP) and have until November 2008 to develop a strategy to reduce the risk of TRALI from apheresis platelets.

Bonfils Blood Center has been working on TRALI risk reduction since March 2005. We have also been working on ensuring an adequate blood supply for Colorado for the past 65 years. Bonfils currently has a four-pronged strategy to assure an adequate blood supply for the Colorado community, meet the industry needs for reducing the risk of TRALI in patients receiving transfusion and increase our adaptability to new knowledge. The strategy focuses on four areas: stabilizing the supply chain, aggressively monitoring donor and product suitability, refreshing our manufacturing environment and increasing effective communication with our customers. In short, Bonfils has adopted a systems approach to reducing TRALI such that during the first phase, we maintain an adequate platelet inventory through optimizing product collection, reducing unnecessary product wastage and outdates, redesigning our laboratory to become more flexible and scalable and increasing the information we give our customers so we can learn from each other how best to manage the community's platelet inventory.

Testing for HLA antibodies that have been historically identified in TRALI cases is currently being developed to be used as a screening mechanism for blood donors at increased risk for transmitting TRALI. The test assays themselves have not been optimized for blood donor testing but for transplantation testing; therefore, the blood bank industry will have to learn how to use these tests to evaluate blood donors. Bonfils Blood Center is currently investigating the available options. Once an acceptable technology and test panel has been identified, Bonfils will begin testing donors at risk for transmitting TRALI in a phased approach to insure optimal TRALI risk reduction and product availability. For the first phase of testing, Bonfils will likely test women who answer YES to the question, “have you ever been pregnant” and who are frequent apheresis platelet donors. Bonfils will continually assess the need to introduce new tests or to test more of our donor base.

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