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Successful desensitization to immunoglobulin A in a case of transfusion-related anaphylaxis

Authors

  • Sorena Kiani-Alikhan,

    1. From the Department of Clinical Immunology and Allergy, the Department of Haematological Medicine, and the Institute of Liver Studies, King's College Hospital; and the National Health Service Blood and Transplant, London, United Kingdom.
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  • Patrick F.K. Yong,

    1. From the Department of Clinical Immunology and Allergy, the Department of Haematological Medicine, and the Institute of Liver Studies, King's College Hospital; and the National Health Service Blood and Transplant, London, United Kingdom.
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  • Dorothea Grosse-Kreul,

    1. From the Department of Clinical Immunology and Allergy, the Department of Haematological Medicine, and the Institute of Liver Studies, King's College Hospital; and the National Health Service Blood and Transplant, London, United Kingdom.
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  • Susan E. Height,

    1. From the Department of Clinical Immunology and Allergy, the Department of Haematological Medicine, and the Institute of Liver Studies, King's College Hospital; and the National Health Service Blood and Transplant, London, United Kingdom.
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  • Aleksandar Mijovic,

    1. From the Department of Clinical Immunology and Allergy, the Department of Haematological Medicine, and the Institute of Liver Studies, King's College Hospital; and the National Health Service Blood and Transplant, London, United Kingdom.
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  • Abid R. Suddle,

    1. From the Department of Clinical Immunology and Allergy, the Department of Haematological Medicine, and the Institute of Liver Studies, King's College Hospital; and the National Health Service Blood and Transplant, London, United Kingdom.
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  • Mohammad A.A. Ibrahim

    1. From the Department of Clinical Immunology and Allergy, the Department of Haematological Medicine, and the Institute of Liver Studies, King's College Hospital; and the National Health Service Blood and Transplant, London, United Kingdom.
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Sorena Kiani, Department of Allergy and Clinical Immunology, King's College NHS Foundation Trust, London SE5 9RS UK; e-mail: skiani@nhs.net.

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.

CASE REPORT: 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.

CONCLUSION: This approach could prove very useful in similar cases that may require administration of large quantities of blood products particularly in emergency lifesaving circumstances.

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