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Transfusion Management of Patients with IgA Deficiency and Anti‐IgA during Liver Transplantation

Severe anaphylactic or allergic reactions may occur during blood transfusion to patients who are IgA‐deficient and have anti‐IgA in their blood, particularly those with class‐specific antibodies. These patients are a particular challenge to the hospital transfusion service when large volumes of blood components are required for transfusion support, as in liver transplantation. We have successfully provided blood components for 3 such patients undergoing liver transplantation. Red cells were washed manually or by automated technique. Platelets were washed manually. All plasma was from IgA‐deficient donors. One patient's entire plasma requirements were supplied by autologous plasmapheresis. Serial determinations of IgA levels and anti‐IgA titers in 1 patient demonstrated an abrupt fall in anti‐IgA with the appearance of barely detectable amounts of IgA during the surgery. IgA‐containing plasma cells were demonstrated in the biopsies of liver homografts of 2 patients following transplantation. IgA deficiency with anti‐IgA can be successfully managed during liver transplantation with advance planning.