Evolving TRALI Risk Across Apheresis and Whole Blood Platelet Products in the U.S.: An 18-Year American Red Cross Hemovigilance Analysis

Transfusion-related acute lung injury (TRALI) is still a leading cause of transfusion-related death in the US. Donor-based safety measures have cut the risk from plasma and apheresis platelets. However, pooled platelets made from whole blood don’t have to undergo the same screening, and their remaining risk has been unclear. This CME activity is based on a study in Transfusion that analyzed 18 years of American Red Cross hemovigilance data (2006–2023), covering more than 130 million distributed blood components and 393 high-probability TRALI cases. It found:

  • Plasma: TRALI from plasma fell from 20 to fewer than 4 cases per million units after the switch to mainly male plasma donors.
  • Whole blood pooled platelets: they averaged 13.5 TRALI cases per million units.
  • Apheresis platelets: stored in plasma, 4.4 cases per million; in platelet additive solution, 0.8 per million; pathogen-reduced, 0.5 per million.

The activity explains why these differences exist. It also covers what they mean for choosing platelet products, and the case for applying measures such as male-predominant pooling and donor antibody screening to whole blood platelets if their use grows.

Target Audience

Healthcare Professionals 

Learning Objectives

  • Describe how TRALI develops, including the two-hit model and the role of donor HLA and HNA antibodies.
  • Explain how donor-based safety measures, such as mainly male plasma donors and HLA antibody screening, have changed TRALI risk over time.
  • Compare how much TRALI risk remains with whole blood pooled platelets and with different types of apheresis platelets.
  • Assess whether additional safety measures are needed for whole blood pooled platelets, and what that means for choosing platelet products.

Activity Disclosure

No commercial support has been accepted related to the development or publication of this activity.

This activity underwent peer review in line with the standards of editorial integrity and publication ethics. Conflicts of interest have been identified and resolved in accordance with John Wiley and Sons, Inc.’s Policy on Activity Disclosure and Conflict of Interest.

Course summary

Available credit: 
  • 1.00 AMA PRA Category 1 Credit(s)™
Course opens: 
12/08/2025
Course expires: 
12/07/2028
Cost:
$0.00

Article Authors

Young PP, Singh U, Webb J, and Looney MR

CME Editor

 

Julie Katz Karp MD

Julie Katz Karp MD

Julie Katz Karp MD has nothing to disclose.

 

John Wiley & Sons, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

John Wiley and Sons, Inc. designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity. For information on applicability and acceptance of continuing medical education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within 1 hour. To successfully earn credit, participants must complete the activity during the valid credit period, which is up to three years from initial publication. Additionally, up to 3 attempts and a score of 70% or better is needed to pass the post test and claim CC credit. [ACGME competency/CC category: Medical Knowledge].

Available Credit

  • 1.00 AMA PRA Category 1 Credit(s)™

Price

Cost:
$0.00
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