engleski

Anaphylactic transfusion reaction caused by IgA immunodeficiency

Anaphylactic transfusion reaction usually begin within 1-45 minutes after the start of the infusion. In general, the shorter the time interval between initiation of the transfusion and onset of symptoms, the more severe reaction is going to be. The purpose is to describe a patient with severe unexpected anaphylactic transfusion reaction. 40-year-old man was received on medical treatment because he had sideropenic anemia. He had never been transfused before. He was afebrile. The results before transfusion: group B, Rh +, DAT, IAT and crossmatched blood negative. After the receipt of about 5 mL of RBCs occured immediate reaction. Patient felt chest tightness and warmth. He also felt pain on the back, abdomen and on the chest. He was sweating. Blood pressure was 130/80, pulse 90/min, and fevere 37, 6 degree Celzius. There was no cutaneous manifestations. On the lungs he had no pathologic signs. Immediately the transfusion was stopped. The patient received 80 mg methylprednisolon intravenously (1 mg/kg). After 20 minutes patient had no symptoms, and was afebrile. The main problem was to determinate the cause of the reaction. We suspected it was immediate hemolytic transfusion reaction or that RBCs was contaminated with bacteria. All the investigations did't give us the answer. The next day, he received a new dosis of RBCs. After receiving only a few mL, he showed the same symptoms as day before. The transfusion was stopped, and he received the same treatment and 20 minutes later, his condition was stabilised. We assumed that the symptoms occured due to anaphylaxis. We prepared for him three times SAG-M-washed RBCs. During the treatment of anemia, the patient received 1530 mL SAG-M-washed RBCs without premedication. He didn't show any sign of anaphylaxis. IgA immunodeficinecy was diagnosed. We educated the patient that he should always inform his physician of his transfusion requirements. A history of anaphylaxis or severe anaphylactoid transfusion reaction constitutes the only indication for transfusion of washed cellular blood components. In patient with known anti-IgA futher reaction can be prevented by transfusion of IgA-deficient blood components.

blood transfusion; anaphylactic reaction; IgA immunodeficiency

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