[Blood Transfusion in a Patient with Severe Anemia and Immunoglobulin A Deficiency during an Emergency Total...

A 45-year-old woman diagnosed with immunoglobu- lin A (IgA) deficiency during blood donation and undiagnosed with anti-IgA antibodies possession underwent emergency total abdominal hysterectomy due to bleeding from the uterus. The patient needed washed red blood cell (RBC) transfusion to avoid severe reaction to blood transfusion. However, Kitakyushu's Blood Center could not supply adequate RBCs immedi- ately because it was a holiday. The patient her rela- tives, and medical staff decided to use 4 units of trans- fused unwashed RBC to increase-her hemoglobin level from 5.4 to 6.5 g - d1- before anesthesia. We prepared an autologous blood collection device and started anes- thesia. Intraoperatively, 155 g bleeding was noted, and the patient was discharged uneventfully. Selective IgA deficiency is the most common primary hypogamma- globulinemia and is less frequent in the Japanese than in Caucasians. Up to 40% of patients with IgA defi- ciency had anti-IgA antibodies that can cause anaphy- lactic reactions to IgA in transfused blood. Blood cen- ters usually maintain a list of IgA-deficient blood donors to prepare compatible blood components. Wash- ing can remove>99% IgA in blood components that may prevent anaphylaxis. Blood transfusion in the present case might have generated anti-IgA antibodies. The patient would need washed RBCs in a subsequent operation.