The London Times of 6th March 2002 reported :
Lung fear may lead to curb over mothers giving bloodThe National Blood Service said yesterday that it was actively considering restrictions of blood donated by women who have been pregnant because it can trigger a fatal lung condition in the recipient.
Four people are known to have died in Britain in the past four years because they have received blood from donors who are mothers. The same factor is thought to have caused another ten deaths.
Women who have been pregnant produce antibodies to protect themselves from the foreign cells of the foetus, and the levels rise with each pregnancy. These antibodies can cause a rare condition, "transfusion-related acute lung injury" (Trali), in some patients. On average there are about 15 cases a year, most serious.
News of the British deaths emerged after the Food and Drug Administration in America alerted doctors to the problems caused by Trali.
It has established that in the past eight years at least 55 people have died from blood donated by women after their second pregnancy. The blood from one woman caused two deaths and 11 non-fatal cases.
Trali is also caused by donations from people who have previously received blood, although these cases are much rarer.
Trali could be prevented by excluding all previously transfused or pregnant donors, but in Britain this would exclude a fifth of the donor pool and would put essential blood stocks in jeopardy. There are 1.8 million blood donors in England and Wales, donating 2.5 million units of blood a year.
Elizabeth Love, a consultant haematologist and secretary of the Serious Hazards of Transfusion scheme, which monitors the safety of blood transfusion in Britain, said that it was currently examining ways of making the blood from mothers safer.
"Excluding mothers from donating would not be something we would do lightly because the actual number of cases appear to be quite small, but we can't be complacent about them either," she said. "The National Blood Service is taking it very seriously and is actively considering these issues, and whether to take action."
One possibility is for blood from women who have had several pregnancies to be used only in low-risk situations. Because most cases of Trali occur when large amounts of plasma have been transfused, their donations could be limited to transfusions with the plasma removed, such as concentrations of red blood cells. In America the Red Cross and other bodies are considering whether to ask women to stop giving blood if they have been pregnant more than once.
For blood to trigger Trali, a number of conditions must be present. If a mother, either when giving birth or because of small placental leaks during pregnancy, is exposed to foetal white blood cells inspired by the father, her immune system forms antibodies to protect her against them.
If the mother later donates blood to someone with the same antigens, or proteins, as her baby, the mother's antibodies bind with the white blood cells of the transfusion recipient, setting off a reaction that causes extreme breathing difficulty, lung failure and, sometimes, death.
No feasible test for the risk in blood products is available.
Earnest
"Beware the Jubjub bird, and shun the frumious Bandersnatch!" - Rev. Charles Dodgson.