Successful desensitization to immunoglobulin A in a case of transfusion-related anaphylaxis.
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.
Kiani-Alikhan
Sorena
S
Department of Clinical Immunology and Allergy, Institute of Liver Studies, King's College Hospital, London, UK. skiani@nhs.net
Yong
Patrick F K
PF
Grosse-Kreul
Dorothea
D
Height
Susan E
SE
Mijovic
Aleksandar
A
Suddle
Abid R
AR
Ibrahim
Mohammad A A
MA
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
D007070:Immunoglobulin A