title: Successful desensitization to immunoglobulin A in a case of transfusion-related anaphylaxis.
abstract: BACKGROUND
  A history of anaphylaxis after transfusion of immunoglobulin A (IgA)-containing blood products in selective IgA-deficient (sIgAD) patients can be a major problem, particularly in emergencies, when large quantities of blood products are required.
  
  
  METHODS
  A 19-year-old woman with end-stage Type 2 autoimmune hepatitis required liver transplantation as her only remaining treatment option. However, she also had sIgAD, anti-IgA antibodies, and episodes of anaphylaxis after receiving IgA-containing blood products. Liver transplantation would have been extremely challenging due to the difficulty of obtaining sufficient blood products from suitable IgA-deficient donors. Hence, it became imperative to devise a protocol to desensitize her to IgA-containing blood products.
  
  
  RESULTS
  Using a continuous infusion of an IgA-enriched (6 mg/mL IgA) immunoglobulin preparation with gradual increases in concentration, she was successfully desensitized to IgA. Consequently, she was able to receive standard platelets, fresh-frozen plasma, and red blood cells with no complications.
  
  
  CONCLUSIONS
  This approach could prove very useful in similar cases that may require administration of large quantities of blood products particularly in emergency lifesaving circumstances.
authors.affiliation: Department of Clinical Immunology and Allergy, Institute of Liver Studies, King's College Hospital, London, UK. skiani@nhs.net
authors.forename: Sorena
authors.initials: S
authors.lastname: Kiani-Alikhan
authors.forename: Patrick F K
authors.initials: PF
authors.lastname: Yong
authors.forename: Dorothea
authors.initials: D
authors.lastname: Grosse-Kreul
authors.forename: Susan E
authors.initials: SE
authors.lastname: Height
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Mijovic
authors.forename: Abid R
authors.initials: AR
authors.lastname: Suddle
authors.forename: Mohammad A A
authors.initials: MA
authors.lastname: Ibrahim
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000209:etiology* / Q000276:immunology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology* / Q000627:therapeutic use*; D065227:Transfusion Reaction; D055815:Young Adult
chemical_list: D007070:Immunoglobulin A