Washington – The plasma transfused into victims of burns, car crashes and other serious conditions soon will come almost completely from men.
Make no mistake: Women need to donate blood now more than ever as blood supplies become more precarious. But blood banks are beginning to separate out women’s plasma – the liquid part of blood – in an effort to fight a mysterious lung injury that has become the nation’s leading risk from transfusions.
Ask about blood safety, and most people think of HIV or other diseases that, thanks to strict testing, actually are incredibly rare in U.S. transfusions. Today, the top threat is TRALI, or “transfusion-related acute lung injury,” in which transfusions trigger reactions that fill patients’ lungs with fluid, leaving them gasping for air.
Three years ago, Britain began an experiment: reserving male- donated plasma for transfusions and separating plasma donated by women for manufacture into lifesaving drugs, such as clotting factors for hemophiliacs or infection-fighting immune globulin.
TRALI cases plummeted, researchers reported at an international blood meeting last fall.
Now U.S. blood banks are following suit. The Red Cross, which provides about half of the nation’s blood supply, already has shifted to about 95 percent male-donated plasma for transfusions in a few parts of the country and is expanding the policy nationwide this year. A number of independent blood banks, which provide the other half of the nation’s blood, are making the switch too.
When blood is donated, it is separated into its major parts: oxygen-carrying red-blood cells that make up most transfusions, plus platelets and plasma.
Dr. Richard Benjamin, chief medical officer of the American Red Cross, began studying TRALI when cases reported to his agency almost doubled in two years. He found that 60 percent of TRALI fatalities reported to the Red Cross were linked to plasma transfusions.
That’s good news because it points to an easy way to reduce TRALI.
No one knows exactly what causes TRALI. But certain immune cells carried by women who have been pregnant – antibodies that mothers-to-be produce in reaction to their fetus’ foreign father cells – are emerging as a chief culprit.
The antibodies do no harm to mother, baby nor the vast majority of recipients who encounter them in a transfusion. To get TRALI requires what Celso Bianco of America’s Blood Centers calls “a horrible coincidence” in which the transfusion recipient has white-blood cells that just happen to recognize and clash with the donor’s antibodies.
Altogether, the change to using male-donated plasma could prevent about 150 cases of TRALI a year, and 15 deaths, estimates Dr. Patricia Kopko, medical director of BloodSource, a California blood bank that made the male-donor shift Jan. 1.
The switch won’t mean all female-donor plasma goes to drugmaking; supply problems mean a little still will be needed for direct transfusions.
