title: Antibody against immunoglobulin E contained in blood components as causative factor for anaphylactic transfusion reactions.
abstract: BACKGROUND
  Determining the mechanism underlying the development of transfusion reactions is important in transfusion therapy. Two bags of fresh-frozen plasma obtained from a donor (index donor) were implicated in two cases of anaphylactic transfusion reactions.
  
  
  METHODS
  The serum prepared from the index donor plasma transfused into the second patient (Patient 2) was evaluated using cord blood-derived mast cells (CBMCs) incubated with Patient 2 plasma. The component in the serum required for the degranulation was determined and quantified by chromatography in combination with degranulation assay, Western blot analysis, and enzyme-linked immunosorbent assay. The component in the plasma required for CBMC sensitization was determined using human immunoglobulin (Ig)E or normal plasma in place of Patient 2 plasma in the assay. Sera collected from the index donor between 2001 and 2008 were examined for the CBMC degranulation factor.
  
  
  RESULTS
  The donor serum activated CBMCs incubated with Patient 2 plasma. The IgG fraction of the donor serum induced degranulation of CBMCs sensitized with IgE or plasma containing a normal IgE concentration. The IgG anti-IgE at a concentration higher than 2200 ng/mL, which showed CBMC degranulation activity, was detected in the donor sera for at least 7 years.
  
  
  CONCLUSIONS
  Transfusion of a high concentration of the anti-IgE in the donor plasma was suggested to induce mast cell degranulation in the patients leading to the development of anaphylactic transfusion reactions. Antibodies existing in not only the patient circulation but also the transfused blood might cause transfusion-induced anaphylaxis.
authors.affiliation: Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Abe
authors.forename: Eiko
authors.initials: E
authors.lastname: Shimada
authors.forename: Minoko
authors.initials: M
authors.lastname: Takanashi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Takamura
authors.forename: Kyosuke
authors.initials: K
authors.lastname: Motoji
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Okazaki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Satake
authors.forename: Kenji
authors.initials: K
authors.lastname: Tadokoro
mesh_terms: D000707:Anaphylaxis / Q000209:etiology* / Q000276:immunology; D000888:Antibodies, Anti-Idiotypic / Q000009:adverse effects* / Q000097:blood; D016913:Blood Component Transfusion / Q000009:adverse effects*; D001782:Blood Donors; D015153:Blotting, Western; D015550:Cell Degranulation; D002478:Cells, Cultured; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology*; D007074:Immunoglobulin G / Q000009:adverse effects* / Q000097:blood / Q000276:immunology; D008407:Mast Cells / Q000276:immunology / Q000378:metabolism; D008875:Middle Aged; D018448:Models, Immunological; D010949:Plasma / Q000276:immunology*; D010951:Plasma Exchange / Q000009:adverse effects; D011697:Purpura, Thrombotic Thrombocytopenic / Q000628:therapy; D013997:Time Factors
chemical_list: D000888:Antibodies, Anti-Idiotypic; D007074:Immunoglobulin G; C026408:anti-IgE antibodies; D007073:Immunoglobulin E