Transfusion-related acute lung injury : etiological research and its methodological challenges

Abstract

Transfusion-related acute lung injury (TRALI) is the most common serious side effect of blood transfusion. TRALI could be caused by donor leukocyte antibodies, present primarily in female and transfused donors (Chapters 1 and 2). In The Netherlands this led to the exclusion of female 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. Chapters 5 through 7 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 TRALI caused by plasma poor products. Further, we evaluate the effectiveness of the plasma measure and other potential donor deferral strategies at keeping leukocyte antibodies out of the blood supply (Chapter 8), address several common methodological problems in research of side effects of blood transfusions (Chapters 3 and 4) and discuss all our 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 (Chapter 9).