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A new strategy for the prevention of IgA anaphylactic transfusion reactions
Author(s) -
Salama Abdulgabar,
Temmesfeld Bettina,
Hippenstiel Stefan,
Kalus Ulrich,
Suttorp Norbert,
Kiesewetter Holger
Publication year - 2004
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2004.03316.x
Subject(s) - anaphylaxis , medicine , anaphylactic reaction , antibody , gamma globulin , globulin , immunology , anaphylactic reactions , allergy
BACKGROUND: Management of patients with clinically significant anti‐IgA is difficult and unsatisfactory in many aspects. PATIENTS AND METHOD: A 40‐year‐old man with common variable immunodeficiency had a previous history of anaphylaxis after an intramuscular immuno‐ globulin administration. His serum contained anti‐IgA, and he required immunoglobulins for recurrent infections. RESULTS: The administration of intravenous immuno‐ globulins (IVIgG) containing less than 0.1 mg per mL IgA led to an anaphylactic reaction after the transfusion of only 2 to 3 mL. The same IVIgG charge was subsequently pretreated with freshly separated autologous plasma and given to the patient on three consecutive days without any reaction (1.25, 10, and 10 g each in 400 mL plasma). Anti‐IgA activity did not increase, and the patient was treated again without complications. DISCUSSION: Ex vivo pretreatment of IVIgG preparations with autologous plasma appears to be safe and useful in the management of patients with clinically significant anti‐IgA. To achieve a significant IgA blockage, the preparation to be used should not contain large amounts of IgA. CONCLUSION: The strategy described here appears to be safe and may help prevent anaphylaxis in many instances.