Transfusion-related Alloimmune Neutropenia (TRAIN) may overlap with transfusion-related acute lung injury (TRALI). In pure TRAIN there are no pulmonary complications.
TRAIN involves:
(1) a fall in the white blood cell count of a patient after a platelet transfusion or transfusion of fresh frozen plasma (FFP)
(2) the presence of anti-neutrophil alloantibodies in the donor's blood against a human neutrophil antigen (HNA) present in the recipient
(3) subsequent testing shows that the HNA in the recipient is absent in the donor
(4) no other explanation for the sudden neutropenia
In TRAIN there should be no or minimal pulmonary symptoms. A patient with transfusion-related neutropenia and pulmonary symptoms would usually be classified as TRALI.
Differential diagnosis:
(1) autoimmune neutropenia (but often the person might not qualify as a donor)
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