Pulmonary “Hypersensitivity” Reactions Induced by Transfusion of Non-HL-A Leukoagglutinins

Abstract

Abstract In two cases of normovolemic pulmonary edema associated with whole-blood transfusion, clinical manifestations included abrupt onset of chills, fever, tachycardia, dyspnea and cough. Cyanosis and hypotension occurred in the more severe case, and bilateral pulmonary infiltrates without confirmatory evidence of circulatory overload were present in both. Antibody reacting with recipient leukocytes was identified in the donor serum in both cases by the capillary agglutination technic but not by a standard lymphocyte microcytotoxicity method. Characterization of the antibody in Case 1 revealed that it detected a specificity that was probably not directly related to the HL-A locus, the neutrophil antigens NA1, NB1, NC1 or the 5a–5b locus. Although over five years had elapsed since the last pregnancy, both the responsible donors were multiparous, raising concern about the use of whole blood from multiparous donors particularly when multiple transfusions must be administered.