Sudden death of a cynomolgus monkey due to transfusion-related acute lung injury (TRALI) after xeno-transfusion from a minipig

Abstract

Blood transfusion in veterinary science is vital but has not been thoroughly investigated due to the diversity and complexity between species. Here, we introduce the case of a cynomolgus monkey that exhibited loss of pupil reflex and died 1 hour after xeno-transfusion with triple-knockout red blood cells from a minipig. A full necropsy was performed to investigate the cause of death. Gross observations revealed foamy and bloody exudate in the mouth; however, no signs of injury were observed in the upper respiratory tract. The lung weight was nearly 5 times higher than that of similar-aged monkeys. The texture of the lung was sand-like, but red and dark red discoloration was observed throughout the lung. Histological examination revealed restricted hemorrhage in the perivascular region in the lungs and phagocytosis of red blood cells by neutrophils in the liver. Thus, the lesion corresponded to a transfusion-related acute lung injury.