Transfusion related anaphylaxis during orthotopic liver transplantation

Acute non-hemolytic transfusion reactions, consisting of both allergic and febrile reactions, are common occurring in up to 10.2% of transfused blood products, however anaphylaxis, or severe allergic reactions, are rare following transfusion. The incidence of anaphylaxis is more common after the transfusion of plasma containing products with estimations from 1:10,000-33,000 units of platelets and 1:29,000-50,000 units of fresh frozen plasma (FFP) compared with 1:50,000-200,000 units of red blood cells. Despite the rare occurrence, the clinical significance of transfusion related anaphylaxis can be severe with 12 reported fatalities over a 5-year span. We report a case of FFP related anaphylaxis in a patient anticipating orthotopic liver transplant (OLT) with a unique peri-operative treatment plan.