• Pearl Toy, Peter Bacchetti, Barbara Grimes, Ognjen Gajic, Edward L Murphy, Jeffrey L Winters, Michael A Gropper, Rolf D Hubmayr, Michael A Matthay, Gregory Wilson, Monique Koenigsberg, Deanna C Lee, Nora V Hirschler, Clifford A Lowell, Randy M Schuller, Manish J Gandhi, Philip J Norris, David C Mair, Rosa Sanchez Rosen, and Mark R Looney.
• Department of Laboratory Medicine, University of California at San Francisco, San Francisco, California.
• Transfusion. 2015 May 1;55(5):947-52.

BackgroundPossible transfusion-related acute lung injury (pTRALI) cases by definition have a clear temporal relationship to an alternative recipient risk factor for acute respiratory distress syndrome (ARDS). We questioned whether transfusion factors are important for the development of pTRALI.Study Design And MethodsIn this nested case-control study, we prospectively identified 145 consecutive patients with pTRALI and randomly selected 163 transfused controls over a 4-year period at the University of California at San Francisco and the Mayo Clinic (Rochester, Minnesota).ResultsFor pTRALI, we found evidence against transfusion being important: receipt of plasma from female donors (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.29-2.3; p = 0.70), total number of units transfused (OR, 0.99; 95% CI, 0.89-1.10; p = 0.86), and number of red blood cell and whole blood units transfused (OR, 0.78; 95% CI, 0.59-1.03; p = 0.079). In contrast, we found that risk for pTRALI was associated with additional recipient factors: chronic alcohol abuse (OR, 12.5; 95% CI, 2.8-55; p < 0.001), current smoker (OR, 4.2; 95% CI, 1.67-10.8; p = 0.0024), shock before transfusion (OR, 4.6; 95% CI, 2.0-10.7; p < 0.001), and positive fluid balance before transfusion (OR, 1.32/L; 95% CI, 1.20-1.44; p < 0.001).ConclusionRecipient risk factors for ARDS rather than transfusion risk factors predominate in pTRALI.© 2014 AABB.

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