Anaphylactic reaction with prothrombin complex concentrate in a patient with IgA deficiency and anti-IgA antibodies

Immunoglobulin A (IgA) deficiency with anti-IgA antibodies is not listed as an absolute or relative contraindication for the use of prothrombin complex concentrates (PCCs). We discuss a patient who developed an anaphylactic reaction to PCC on a background of selective IgA deficiency with anti-IgA antibodies and with a history of anaphylactic reaction to other blood products. Further analysis of PCCs revealed the presence of variable quantities of immunoglobulins of all classes, including IgA. Although the summary of product characteristics for PCCs from various manufacturers does not list IgA deficiency with anti-IgA antibodies as an absolute or relative contraindication, our findings suggest that PCCs are not devoid of IgA and great caution must be exercised with their use in patients with IgA deficiency with anti-IgA antibodies and with previously documented reactions.