Transfusion management of patients with IgA deficiency and anti-IgA during liver transplantation.
Severe anaphylactic or allergic reactions may occur during blood transfusion to patients who are IgA-deficient and have anti-IgA in their blood, particularly those with class-specific antibodies. These patients are a particular challenge to the hospital transfusion service when large volumes of blood components are required for transfusion support, as in liver transplantation. We have successfully provided blood components for 3 such patients undergoing liver transplantation. Red cells were washed manually or by automated technique. Platelets were washed manually. All plasma was from IgA-deficient donors. One patient's entire plasma requirements were supplied by autologous plasmapheresis. Serial determinations of IgA levels and anti-IgA titers in 1 patient demonstrated an abrupt fall in anti-IgA with the appearance of barely detectable amounts of IgA during the surgery. IgA-containing plasma cells were demonstrated in the biopsies of liver homografts of 2 patients following transplantation. IgA deficiency with anti-IgA can be successfully managed during liver transplantation with advance planning.
Davenport
R D
RD
University of Michigan Hospitals, Ann Arbor.
Burnie
K L
KL
Barr
R M
RM
D000293:Adolescent; D000328:Adult; D001323:Autoantibodies; D001803:Blood Transfusion / Q000379:methods; D004912:Erythrocytes; D005260:Female; D006801:Humans; D017098:IgA Deficiency / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D065227:Transfusion Reaction
D001323:Autoantibodies