Prevention - Anaphylactic Transfusion Reactions

Strategies for preventing anaphylactic/anaphylactoid transfusion reactions can be considered in three categories:

1. No IgA deficiency and no detectable anti-IgA

If the patient is not IgA deficient and no anti-IgA has been detected, and has experienced only a single anaphylactic or anaphylactoid reaction, a trial transfusion of unwashed blood components may be performed. The transfusion should be given under controlled clinical conditions, and close medical supervision as described below:

• obtain informed consent from the patient
• transfuse RBC, platelets, or plasma as indicated from unselected donors
• transfuse under close medical supervision (direct nursing supervision and physician immediately available)
• premedicate to reduce the severity, with emergency therapy readily available
• resume transfusion of standard blood components if no anaphylactic and anaphylactoid transfusion reaction occurs
• if anaphylactic or apaphylactoid reaction occurs, transfuse with washed blood components

2. Detectable anti-IgA (or anti-IgA levels pending)

For patients with anti-IgA or anti-IgA levels pending, transfuse with IgA deficient blood components. (See following table)

 3. IgA deficiency without detectable anti-IgA

Patients with IgA deficiency but without detectable anti-IgA who have experienced an anaphylactic or anaphylactoid transfusion reaction, should be treated as in (2) above. However it is possible that their transfusion reaction was unrelated to the IgA deficiency. For patients with IgA deficiency but without detectable anti-IgA who have never experienced an anaphylactic or anaphylactoid transfusion reaction, periodic repeat testing for anti-IgA may be considered before commencing subsequent elective transfusion. However, it is not necessary to routinely administer IgA deficient products to these patients.