Possible Transfusion-Related Acute Lung Injury Following Convalescent Plasma Transfusion in a Patient With Middle East Respiratory Syndrome

Chun, Sejong; Chung, Chi Ryang; Ha, Young Eun; Han, Tae Hee; Ki, Chang-Seok; Kang, Eun-Suk; Park, Jin Kyeong; Peck, Kyong Ran; Cho, Duck

TRALI is defined as a new onset of acute lung injury (ALI) within six hours of transfusion, with evidence of hypoxia (PaO2/ FiO2 ≤ 300 mmHg or SpO2 < 90% of room air) and radiological evidence. Additionally, it does not require evidence of left atrial hypertension, preexisting ALI, or temporal relationship to an alternative risk factor for ALI. In our case, as the onset of hypoxia happened two hours after convalescent plasma infusion and both SpO2 (Oxygen saturation as measured by pulse oximetry) and PaO2/FiO2 (Fraction of inspired oxygen) levels met the criteria for TRALI with no auscultative findings of circulatory overload, TRALI was suspected. Since MERS can also result in ALI, we recognized that a temporal risk factor existed; thus, our patient met the criteria for possible TRALI. As both antibodies for HLA and HNA were negative, the underlying mechanism is thought to be non-antibody mediated. The finding that the Ct value in the qPCR increased after transfusion suggested that passive immunotherapy could decrease the viral burden of MERS-CoV. However, further investigation with a controlled study and a larger number of subjects is required to determine the clinical benefits of this therapy. As in any other blood component donation, precautions are needed to prevent adverse transfusion effects. To specifically prevent antibody-mediated TRALI, it is recommended that plasma be processed from male donors only [5] . However, the majority of potential donors for convalescent plasma were female nurses. Thus, the male-only protocol was waived during the MERS outbreak. A case of non-HLA antibody-mediated TRALI after convalescent plasma use in an Ebola virus disease patient was recently reported [6] .