TRALI Investigation Services

Transfusion-Related Acute Lung Injury (TRALI) is characterized by acute non-cardiogenic pulmonary edema and respiratory compromise in the setting of transfusion. The precise mechanism responsible for TRALI is unknown, but it is thought to be triggered by passive transfer of HLA antibodies present in the plasma of the transfused blood product. Less than 5% of TRALI cases are, however, associated with the presence of the causative antibodies in the recipient that react with transfused cellular material.

Clinical Utility:

Donor Screening: Since TRALI has been shown to be associated with the transfusion of blood components containing HLA antibodies, American Association of Blood Banks (AABB) guidelines and standards require that that blood collection and transfusion facilities implement interventions to minimize the preparation of high plasma-volume components from donors known to be leukocyte-alloimmunized or at increased risk of leukocyte alloimmunization. Our laboratory offers HLA antibody testing for the purpose of donor screening.

TRALI Evaluation: TRALI has been attributed to donor leukocyte antibodies that are thought to interact with recipient neutrophils, resulting in activation and aggregation in pulmonary capillaries, release of local biologic response modifiers causing capillary leak, and lung injury. Testing plasma samples from the implicated donor(s) and patient for leukocyte antibodies is helpful in evaluation of a suspected TRALI case.


The laboratory uses a panel of color-coded microspheres coated with purified HLA antibodies to determine percent reactivity of antibodies present in tested plasma.  Test serum or plasma is first incubated with these coated beads. Any HLA antibodies present in the test serum bind to the antigens on the beads and will be detected fluorescently using a flow analyzer.

Specimen Requirements:

Any of the following specimens are acceptable for leukocyte antibody testing:

One 5-mL EDTA (purple top) or ACD (yellow top) tube
- sent overnight at room temperature
One clot (red top) tube
- sent overnight at room temperature
Separated serum (from clotted samples) or plasma (in ACD or K-EDTA) refrigerated up to 5 days
- sent overnight on wet or dry ice
Separated serum (from clotted samples) or plasma (in ACD or K-EDTA) frozen up to one year
- sent overnight on dry ice

Shipping Requirements

Samples are accepted Monday through Friday. Overnight shipments should be sent Monday through Thursday. Please overnight samples, as specified above, along with the completed test requisition to:

Kashi Clinical Laboratories, Inc.
Attention: HLA Laboratory
10101 SW Barbur Blvd, Suite 200
Portland, OR 97219