Alloantibodies against granulocytes

Granulocyte-reactive alloantibodies, mainly HLA class I and granulocyte-specific ones, are the main cause of febrile transfusion reactions. Typically in this reaction the temperature begins to rise sharply a few hours after the transfusion which is often accompanied by chills. The temperature begins to decline after about 8 h. The reactions are due to anti-body-antigen complexes liberated after the destruction of leukocytes. These complexes bind to and activate monocytes, which, after a delay, release cytokines with pyrogenic properties. These reactions can be prevented by removing most of the leukocytes from red cell and platelet concentrates, e.g. by filtration.

A much more serious reaction, transfusion-related acute lung injury (TRALI) is characterized by chills, fever, a nonproductive cough, dyspnea, and infiltration and edema of, particularly, the lower lung fields. The reaction, which may be fatal, is nearly always due to the presence of leukocyte antibodies in the donor plasma, although rarely it has been caused by antibodies in the recipient. Donors whose blood induced the TRALI should be removed from the donor panel.

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