IgA deficient patient needing rbc transfusions

[dcharland]

Has anyone had experience transfusing an IgA deficient patient with anti-IgA antibodies >1000U (and anti-c) with RBCs? I understand deglycerolized rbcs are first choice and then second choice is washed (X2) RBCs.

Is deglycerolizing really necessary?

[janet]

Are you looking at deglycerolized because they are IgA deficient and/or c negative??

I believe to truly remove IgA and prevent an anaphylactic reaction the unit needs to be washed 6 times (not that we wash .... that is what I was told - the units aren't deglycerolized only washed)

[bmarotto]

We have an IgA deficient patient with multiple antibodies (anti-Kell, anti-s, and anti-Dombrock . We have given her RBCs that we washed with 2 liters of saline and she has tolerated them without any problem.

[David Saikin]

Washed rbc are indicated for IgA deficient patients

[mda]

I agree with David.

[mhc]

Another strategy might be to provide products from IgA deficient donors. Usually we get plasma or platelets that are IgA deficient, but I dont see why your blood center couldnt find RBC donors as well, especially using the great apheresis technology that is available. You could freeze and stockpile them if your patient is a chronic user.

With a high titer anti-IgA like that, I would want to make sure that the washing process removes as much IgA from the unit as possible, if washing is the method of choice. You should validate your process before you transfuse that patient with washed RBCs.

[mcharapata]

A follow-up question in regards to validation of 2x wash for an IgA deficient patient is "what would you establish as the acceptance criteria for residual IgA levels after wash?" Is anyone aware of a publication that could point me in the right direction (or have any thoughts on what to establish as criteria)?

[Liz]

We wash 3x.

[mhc]

"IgA content of washed red blood cell concentrates" (Vox Sang 1998 74:13-14) might be a start.