Evolving <scp>TRALI</scp> risk across apheresis and whole blood platelet products in the United States: An 18‐year American Red Cross hemovigilance analysis
Bibliographic record
Abstract
BACKGROUND: Transfusion-related acute lung injury (TRALI) remains a leading cause of transfusion-associated mortality in the United States. Donor-based mitigation has reduced TRALI risk from plasma and apheresis platelets, but the residual risk associated with whole-blood-derived pooled platelets is not well defined. STUDY DESIGN AND METHODS: We retrospectively analyzed transfusion reactions reported to the American Red Cross (ARC) national hemovigilance program from 1 January 2006 through 31 December 2023. Reactions were adjudicated using Canadian Consensus Conference criteria; definite or highly probable TRALI cases (levels 5-6) were included. Component distribution data served as denominators. Trends were evaluated in relation to two mitigation efforts: male-predominant plasma (2005-2006) and HLA-antibody screening of previously pregnant apheresis-platelet donors (2016). RESULTS: Over 18 years ARC distributed 92.7 million red blood cells, 23.5 million plasma units, and 17 million platelets-including 0.87 million pooled WB-derived platelets, 11.7 million plasma-suspended apheresis, 1.5 million PAS apheresis, and 2.9 million pathogen-reduced (PR) platelet-additive solution-3 (PAS) apheresis platelets. We identified 393 high-probability TRALI cases. Plasma-associated TRALI declined from 20.0 to <4 cases per million units following male-predominant policies; RBC risk remained stable (0.7-4.3/million). TRALI incidence for whole blood pooled platelets averaged 13.5/million, exceeding plasma-suspended (4.4/million), PAS (0.8/million), and PLT PR PAS (0.5/million) apheresis platelets (p = .002 for differences among apheresis subtypes). Compared to apheresis PLT, the TRALI incidence for whole blood PLTS is increased by about 9-13/million. CONCLUSION: Current mitigation strategies, which are not required for whole blood derived platelets in the United States, have substantially reduced TRALI risk from apheresis platelets. If whole blood-pooled platelets production in the United States increases, consideration should be given to the addition of mitigation strategies-such as male-predominant pooling and donor antibody screening-to align their safety profile.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".