Anti‐HNA testing of allo‐exposed COVID‐19 convalescent plasma donors including genetic human neutrophil antigen screening to prevent anti‐HNA antibody‐mediated transfusion‐related acute lung injury

Abstract

AbstractBackgroundTransfusion‐related acute lung injury caused by antibodies against human neutrophil antigens (HNA) is a serious but rare complication associated with blood transfusion. The presence of such antibodies is most probable in donors with a transfusion/pregnancy history. During the COVID‐19 pandemic period convalescent plasma (CP) containing neutralizing antibodies against SARS‐CoV‐2 was widely used for COVID‐19 patients as a therapy in the absence of any treatment. The aim of the study was to work out a simple diagnostic algorithm of anti‐HNA testing of allo‐exposed CP donors including genetic HNA screening.Materials and MethodsA total of 457 anti‐HLA‐negative allo‐exposed CP donors were genotyped for HNA‐1a/1b, HNA‐3a/3b, and HNA‐2, and only donors with homozygous HNA‐1a/1a; HNA‐3b/3b; or HNA‐2null genotypes were tested for anti‐HNA antibody using LabScreenMulti (One Lambda) and homozygous HNA‐1b/1b using the granulocyte immunofluorescence test (GIFT) but verified using LabScreenMulti.ResultsTesting of 83 homozygous HNA‐3b/3b; HNA‐2null; or HNA‐1a/1a donors revealed anti‐HNA‐3a antibody in one case. Testing of 181 HNA‐1b/1b donors using GIFT gave 10 ambiguous results verified using LabScreenMulti which confirmed anti‐HNA‐1a antibody in one case. The frequency of FCGR3B*01 and *04 encoding HNA‐1a was 0.34; FCGR3B*02, *03, and *05 encoding HNA‐1b—0.66; SLC44A2*01 encoding HNA‐3a—0.80; and SLC44A2*02 encoding HNA‐3b—0.20. In 3.7% cases the HNA‐2null genotype was revealed.DiscussionDue to applying HNA genotyping as a primary test before anti‐HNA antibody testing the serological work was limited only to HNA‐homozygous donors revealing two anti‐HNA immunized donors. The distribution of HNA genotypes in the cohort was similar to other Caucasian populations.