IgA deficient OB patient with placenta previa & vasa previa

[Mabel Adams]

We have just learned that we have a 32 week pregnant IgA deficient mom admitting tomorrow for observation for the next 2 weeks with plans to deliver at about 34 weeks by C-section because of placenta previa and vasa previa.  There is no record of anti-IgA testing that we can see.  This is not her first pregnancy--G3P2. She is about 30 years old and was identified as IgA deficient 5 years ago.  She is donating 2 autologous RBC and FFP units.  I assume there is no extra risk for the baby.  We are 3.5 hours' drive from our blood supplier. Any advice appreciated as we create a plan for dealing with possible hemorrhage.

[Neil Blumberg]

Most patients with IgA deficiency and even with anti-IgA do not have anaphylactic or allergic reactions.  Unless she has a history of anaphylaxis/atopy I wouldn't worry.  In an hemorrhagic emergency, just transfuse and, as always, have some epinephrine on hand for reactions.  It's well established now that most anaphylactic reactions happen in atopic patients and IgA deficiency has nothing to do with it, in general.  See work by Gerald Sandler, et al. on the subject or listen to the Blood Bank Guy podcast by Sandler.  Be happy, don't worry.

[galvania]

might be worth checking to see if she actually has antibodies to IgA

[AMcCord]

We've seen one of those patients with the antibody who had the severe anaphylactic reaction - impending sense of doom, etc., just like the books say. Fortunately the nurse was very attentive when the transfusion was started and caught it immediately. My advice is to instruct the nurses to watch very closely if she is transfused and make sure they know how to recognize a reaction if it occurs.

[Mabel Adams]

We have sent out a test for the antibody plus ARC wanted us to do a high sensitivity test for the antigen so we are doing that.  One of the providers wondered if she should wear a medical alert bracelet.  I was a bit ambivalent because I wouldn't want anyone to be afraid to transfuse her if she really needed it.  I said the wording should be to avoid transfusion unless life-threatening emergency and prepare for possible anaphylactic reaction if transfusion needed.  Of course, this is only if she has the antibody and maybe then it is excessive.  Thanks for your input.  I welcome additional information.

[AMcCord]

Mabel - our patient is wearing a medical alert bracelet which says that she has the antibody. Not sure exactly what it says about transfusions as her provider dealt with the details. The patient (former nurse) and her husband are both very aware of what her problem is so are able to communicate effectively about her situation, which is very helpful. We were contacted by another facility not too long ago w/ questions about her as they were making plans for a surgical procedure - did we actually test for the antibody? (we did), symptoms of her reaction, etc. She is now, understandably, very reluctant to consent to transfusions.

Edited July 17, 2019 by AMcCord