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Arno

IgA deficiency testing before convalescent plasma transfusion

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Posted (edited)

Hi there! I hope you are all doing well.

 The Italian blood transfusion society has made the screening of Covid-19 patient for IgA deficiency systematic before the transfusion of convalescent plasma. 
http://isbtweb.org/fileadmin/user_upload/Italy.pdf
Would like to know what is your position in this regards and is there any similar existing guidelines? Thank you in advance

Edited by Arno

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I disagree. First of all, most patients with IgA deficiency and anti-IgA do not experience anaphylaxis.  Secondly patients with anaphylaxis (a rare event indeed) do not have usually have IgA deficiency, much less anti-IgA antibody (see work by G. Sandler and colleagues refuting the ancient report of a handful of patients).  Thus, to me,  this is a waste of time and money and unnecessary.  The key to safe plasma transfusion from this standpoint is to take about 30 minutes to run in the first 15 milliliters or so, and have a crash cart with epinephrine available should anaphylaxis occur (which, 99,999 out of 100,000 times it won't).  And take a history of previous anaphylactic reactions to insect stings, dietary constituents, etc.  Those patients you might want to be very careful with.

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Hello, thanks for your post.  Anything is possible every single time we administer blood products.  I agree with Neil, especially on the patient's history inquiry.  I would be more concerned about other infectious bugs, than with possible rare reactions due to IgA deficiencies, and even then, I am not too concerned.  At this point, an injection of CCP and  prayers are in order.  Patients are responding.  Good day.

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The Sandler reference is Sandler, et al Transfusion 2015;55:199-204. I see the Italian document recommends testing for IgA, At a routine hospital level of detection (5mg/dL) there will be some patients interpreted as IgA deficient and deferred from getting CCP by the Italian guidelines that do have detectable IgA by more sensitive testing. There is no mention of IgA testing in the WHO Interim Guidance document (Teo D et al) posted on the ISBT Website. The USA American Rare Donor Program (ARDP) uses a level of 0.05 mg/dL to define IgA deficiency for donors and patients. The ARDP has an algorithm for requests for IgA deficient products, and in general,  fills requests for IgA deficient plasma containing products only for patients having anti-IgA and/or a documented anaphylactic reaction. Red cells can, in general, be washed or be frozen/deglyced for exquisitely sensitive patients.

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Thank you for your feedback - much appreciated.

This confirms my understanding and what I have read so far on this topic.

Thanks again.

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