Transfusion-related acute lung injury : etiological research and its methodological challenges
Middelburg, R.A.
Citation
Middelburg, R. A. (2011, January 19). Transfusion-related acute lung injury : etiological research and its methodological challenges. Retrieved from https://hdl.handle.net/1887/16345
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License: Licence agreement concerning inclusion of doctoral thesis in the Institutional Repository of the University of Leiden
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Summary
Rutger A. Middelburg
Summary
155 Transfusion-related acute lung injury (TRALI) is currently the most common serious side effect of blood transfusion. As described in Chapter 1 and shown quantitatively in Chapter 2, the TRALI literature until December 2007 largely consisted of case reports and case series. There was a strong suggestion that TRALI could be caused by donor leukocyte antibodies, present primarily in parous female donors and transfused donors, which activate recipient neutrophils. In The Netherlands this suggestion led to the exclusion of female donors and transfused donors from the donation of plasma for transfusion from 1st October 2006. In this thesis we aimed to quantitatively estimate the expected effect of the implementation of this measure.
In Chapters 3 and 4 we describe and solve several common methodological problems in research of side effects of blood transfusions in general and TRALI in particular. Two of the methods proposed in Chapter 4 are then used in Chapters 5 and 6 to study the contribution of female donors and allo-exposed donors to the occurrence of TRALI.
Chapter 7 gives an estimate of the actual effect of the plasma measure in The Netherlands on the incidence of TRALI. The results from Chapters 5 through 7, though obtained through completely different approaches and partly in different populations, are in close agreement. Together these chapters suggest nearly all TRALI caused by plasma rich products to be preventable by the deferral of female or allo-exposed donors, while there is no such effect on the incidence of TRALI caused by plasma poor products.
In Chapter 8 we also evaluate the effectiveness of the plasma measure at actually keeping leukocyte antibodies out of the blood supply. This effectiveness is then compared to other potential donor deferral strategies. It is shown that the deferral of only self-reported allo-exposed donors is as effective as deferral of all female and transfused male donors. In terms of donor management deferral of allo-exposed donors only would be more efficient, but in effectiveness to prevent TRALI there is no difference.
Finally, in Chapter 9, we discuss these findings and some more general issues concerning the use of the population attributable risk, as opposed to the relative risk, and correction of the population attributable risk for confounding.
