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BOOK REVIEWS
TRALI: Mechanisms, Management, and
Prevention. Edited by Kleinman S, Popovsky MA,
2008, AABB Press, Bethesda (Md), (196 pages)
HIS IS AN up-to-date text on transfusion-
T related acute lung injury (TRALI) by 2 indi-
viduals well versed in the field, Dr Steven Kleinman
and Dr Mark Popovsky. They have assembled a
number of transfusion medicine specialists to author
most of the chapters and provide a comprehensive
overview of TRALI. The chapters tend to be well
referenced and are nicely illustrated; however, there
is some duplication between chapters. Especially
useful is a table, in chapter 2, on the differential
diagnosis of pulmonary transfusion reactions.
Although the 2 proposed mechanisms for TRALI
are carefully evaluated, the evidence for leukocyte
antibodies as the main cause of TRALI is most
compelling. Thus, various studies cited that 61% to
90% of blood components implicated in TRALI
events have detectable leukocyte antibodies. When
not found in the donors, they are sometimes detected
in patients reacting with the leukocytes present in a
nonleukoreduced transfused component. Further,
TRALI has been elicited in healthy volunteers
infused with leukocyte antibody–containing com-
ponents, showing that this is sufficient to cause a
TRALI event without invoking some underlying
disease or associated clinical condition. Bioactive
lipids in a “2-hit” model of TRALI may explain
some cases of TRALI where red blood cell (RBC)
concentrates near their outdate are implicated and no
leukocyte antibodies can be identified in the blood
component associated with that TRALI event. This
mechanism however does not explain cases wherein
plasma-only or plasma-rich components alone
appear to cause a TRALI event. This occurs even
if leukocyte antibodies are not found; assuming a
thorough search had been made for the latter.
There are some flaws and missing items in this
otherwise authoritative work. These include (a) a
critical assessment as to why TRALI does not result
when leukocyte antibodies are transfused to a blood
component recipient whose leukocytes bear the
cognate antigen; (b) a discussion of the relevance of
the brain natriuretic peptide, which is now referred
to as B or beta natriuretic peptide and other similar
Transfusion Medicine Reviews, Vol 23, No 3 (July), 2009: p 229-231
or related peptides that have been described; (c) the
reason why only the lungs appear to be affected
during TRALI-related events; (d) why only the
transplanted lung was affected in the case reported
by Dykes et al (Br J Haematol 2000;109:674-676) is
not explained; (e) possible approaches to reducing
the risk of TRALI should have been more
thoroughly covered, especially for platelets and
RBC transfusions; (f) the use of platelet additive
solutions, RBC additive solutions, leukoreduction,
pathogen reduction processes, and pooling plasma
before viral inactivation processes should also have
been mentioned; and most importantly, (g) commu-
nication with implicated donors, for example,
sample letters and a discussion of their impact on
donors, should have been presented.
Overall, TRALI: Mechanisms, Management, and
Prevention is a good review and summary of this
important topic. With the publication of this book,
much current information on TRALI is now
available in a single volume.
Paul V. Holland
UC Davis Medical Center
Sacramento, CA
Delta Blood Bank
Stockton, CA
E-mail address: pvh@abotogo.com
Judd's Methods in Immunohematology. Edited by
W. John Judd, Susan T. Johnson, Jill R. Storry, 3rd ed,
2008, AABB Press, Bethesda (Md)
HE TOPIC OF immunohematological meth-
T ods deserves a prominent place among the
concerns of blood bankers because of the plethora of
methods that exist and the fact that adequate training
for many bench technologists who might be faced
with serological incompatibilities is not as common
as it once was. Thus, books that clearly indicate
0887-7963/09/$ - see front matter
© 2009 Published by Elsevier Inc.
doi:10.1016/j.tmrv.2009.03.005
229
 Author's personal copy
230
appropriate methods to be used for specific serolo-
gical problems are extremely valuable. This latest
edition of the previously titled Methods in Immuno-
hematology provides the comprehensiveness and
clarity for those individuals interested in serological
(immunohematological) investigations. It has been
16 years since the last (second) edition of this book,
and this third edition has little resemblance to its
previous counterpart. For one thing, the page number
has increased in this edition from 476 pages to 667.
Importantly, however, the printed paper used in this
edition has a much better contrast than the previous
editions, making it much more attractive and easier to
read. One major change from the previous edition is
the inclusion of 2 additional coauthors, Sue Johnson
and Jill Storry, who have complimentary areas of
expertise to that of John Judd. This combination of
authors has allowed for an important evolution of this
valuable reference book.
The format for all the procedures has been changed
to an information mapped style. Processes and
procedures are now described in separate documents
as opposed to the standard operating procedure
(SOP) format where process and procedure were all
contained in 1 document. These procedures are also
contained on a CD-ROM component supplied with
this book, which will allow procedures to be
modified to fit the characteristics of each individual
laboratory. This brilliant addition allows blood bank
transfusion services and immunohematology refer-
ence laboratories to modify them, if necessary, to fit
their laboratory's requirements as a procedure to be
used in their in-house SOPs.
In addition, a new Appendix A is included, which
lists reagent preparations in a step-by-step format
that will benefit many transfusion service and
reference laboratory technologists. Another innova-
tion is the use of process documents that have been
added to the antibody identification section. This
includes a basic approach to be taken when
evaluating initial antibody identification panel
results, including the crossing out and selecting of
cells. This is a nice innovative addition to the book
because there are essentially no other written
materials that provide a step-by-step procedure for
basic crossing out and evaluation of antibody
investigation results. In addition, a written process
and flow charts are provided for evaluating patients
with hemolysis and/or a positive DAT and patients
with antibodies to high-prevalence and low-pre-
valence antigens. This provides the reader with a
BOOK REVIEWS
clear and concise description for the evaluation of
difficult immunohematological problems that will
benefit both bench technologists and clinical
transfusion medicine doctors. New Appendices C
and D have also been added to address the hazards
of, and how to respond to, various chemical spills.
These appendices should be very useful and much
appreciated by both laboratory personnel and
occupational health and safety committees.
The section on the investigation of drug-induced
hemolysis has been totally reorganized and is very
up to date. The most current procedures have been
added for testing drug-treated red blood cells as well
as testing patient serum in the presence of drug. The
different categories of drug-induced hemolytic
anemias have been updated to reflect current
thinking of the mechanisms involved. Another
important addition to this section is the completely
updated Table of Drugs that have been reported to
cause hemolysis and/or a positive DAT. This is the
most up-to-date table on drugs that can cause a
positive DAT and/or hemolysis that currently exists.
Some may believe that the references used in this
edition are somewhat outdated, but I would beg to
differ. Although not extensive for obvious reasons,
I believe that the referencing used in this book is
appropriate. The authors have provided a balance
between the historical literature and more recent
publications. In most cases, the authors include a
citation to the current edition of the AABB
Technical Manual, which has the advantage of
being updated continuously, thus allowing this
edition to be, in a sense, always current. I found the
inclusion of many ‘obsolete’ procedures again, as
for the references used, as providing some historical
significance to the resolution of complex serologi-
cal problems. I also agree with the Preface, which
indicates that including these ‘historical’ proce-
dures ensures that they are not lost and; indeed,
some of these methods could still be applicable,
under certain circumstances, to resolve some very
complex serological problem. One other innovation
to this edition of the book that stands out is the
inclusion of “Limitations” for each of the methods
described. This is not often found in other Methods
books and provides information that is vital to the
understanding of the method being used and how to
troubleshoot, if necessary.
Much has changed over the 16 years since the
appearance of the last edition of this Methods book.
All of the changes that have occurred, particularly
 Author's personal copy

BOOK REVIEWS 231

the way that SOPs are written, have been superbly Donald R. Branch
addressed in this third edition. Overall, this book Associate Professor of Medicine,
offers comprehensive and detailed instructions for a Laboratory Medicine, and Pathobiology
range of serological investigations and problems University of Toronto
that will be very useful to its intended readership. It Toronto, Ontario, Canada
will also be useful for teaching new personnel and Division of Cell and Molecular Biology
refreshing seasoned personnel on the serological Toronto General Research Institute
problems that can appear at any time and how to Toronto, Ontario, Canada
resolve such problems. This book should be Research and Development
required reference material for blood bankers, Canadian Blood Services
immunohematology reference laboratories, as well Toronto, Ontario, Canada
as laboratory and clinical transfusion specialists. E-mail address: don.branch@utoronto.ca