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A new strategy for the prevention of IgA anaphylactic transfusion reactions

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 seru...

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Published in:Transfusion (Philadelphia, Pa.) Pa.), 2004-04, Vol.44 (4), p.509-511
Main Authors: Salama, Abdulgabar, Temmesfeld, Bettina, Hippenstiel, Stefan, Kalus, Ulrich, Suttorp, Norbert, Kiesewetter, Holger
Format: Article
Language:English
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Summary: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.
ISSN:0041-1132
1537-2995
DOI:10.1111/j.1537-2995.2004.03316.x