Transfusion Reaction - Tongue Numbness

[saralm88]

Good Morning Friends

I hope everyone is doing well and staying safe!

I wanted to know if anyone has had a transfusion reaction symptom of tongue numbness along with hives and what was your pathologist's opinion on it.  This patient received a platelet pheresis unit and, immediately after, was receiving a red cell unit and the hives started with the  numbness after about a small amount.  I just wanted to get some feedback about this type of reaction.  Allergic seems good for the hives but the tongue numbness doesn't fit?

Also - could a Psoralen platelet cause something like this?  Apparently, there was some swelling of the lips so i am now going in the direction of anaphylaxis

 

Thank you in advance!! Everyone is always so helpful!

S

Edited September 1, 2020 by saralm88
added info

[BankerGirl]

I had one reaction report early in my career that was only "bleeding tongue" and when I took it to my pathologist, he just rolled his eyes and waved me off.    Just yesterday I read the information sent by ARC regarding allergic reactions to psoralen in platelets and they had this to say:  "...no cases of psoralen or amotosalen hypersensitivity have been reported to Cerus, the manufacturer of INTERCEPT (psoralen-treated) platelets. Psoralen-treated products have been in routine use in patients in Europe (15+ years) and USA (3+ years) with over 5 million psoralen-treated components administered with no hypersensitivity reaction to psoralen reported to date."  Not saying it is impossible, just not previously documented.

[John C. Staley]

Is there any other possible cause of what the patient experienced such as antibiotics or food or anything else?  I'm not saying it's not the transfusion but it does sound much more applicable to other things.  

[Kip Kuttner]

There are many plasma proteins that can cause allergic reactions. Transfusing washed cellular products frequently prevents additional reactions.  In addition, there have been several case reports of a donor consuming an allergen (peanut butter is classic) before donating. The recipient who is sensitive subsequently has an allergic reaction.  One that comes to mind was well documented in the NEJM. And of course don’t forget the controversial IgA deficient patient allergic reactions. 

[Kip Kuttner]

...Also perhaps the “numbness” was related to tongue swelling related to the allergic reaction.