Atypical respiratory distress and transient decrease in absolute neutrophils associated with fresh frozen plasma transfusion

Abstract

Background: Transfusion-related acute lung injury (TRALI) is a clinical diagnosis of exclusion to explain acute respiratory distress following a transfusion. Post-transfusion decrease in absolute neutrophils can increase clinical suspicion for this entity. Case Report: Acute respiratory distress requiring intubation occurred following the transfusion of 1 unit of fresh frozen plasma (FFP) to reverse Coumadin in a 65-year-old male. Radiographs were negative for pulmonary infiltrates, and there were no electrocardiography (EKG) changes or clinical indications of volume overload with the clinical assessment being respiratory distress related to transfusion. Sequential complete blood counts showed transient 27-hour decrease in absolute neutrophils and weak reacting neutrophil antibodies in the never transfused male donor. Conclusion: Acute respiratory distress with no bilateral pulmonary infiltrates differentiates this case from TRALI. A male donor with no history of transfusions (not traditionally considered a TRALI risk) was found to have neutrophil antibodies. We therefore suggest that physicians consider (1) investigating cases not meeting full TRALI criteria and (2) testing donors with no risk for human leukocyte antigen (HLA)/neutrophil antibodies.