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Published on: October 31, 2012
Alpha-gal sensitization and the transfusion medicine diagnostic gap: A single-center study with multi-institutional
Homayemem K Weli1, Caitlin Raymond2, Sameer Mathur3
1Department of Pathology, St Louis University School of Medicine, St Louis, Missouri, USA.
Background:
Transfusion-related-alpha-gal syndrome (TRAGS) is an emerging transfusion complication in which alpha-gal (α-Gal)-sensitized recipients may experience allergic reactions to B antigen-containing plasma-rich blood products. Group O recipients appear to be at greatest risk; group A recipients may also be at risk, whereas group B/AB individuals appear relatively protected in most studies. Identifying at-risk patients requires both knowledge of α-Gal sensitization status and ABO blood group, yet ABO typing among sensitized patients is poorly characterized.
Study Design And Methods:
We retrospectively reviewed alpha-gal-specific IgE (sIgE) tests performed at an academic center in Madison, Wisconsin (2015-2026), assessing documented ABO blood group among patients with sIgE ≥0.10 kIU/L, and reviewing alpha-gal syndrome (AGS) diagnosis, transfusion history, and transfusion reactions. Findings were validated using TriNetX, a federated Network of de-identified U.S. electronic health records, with sensitivity analyses at published sIgE thresholds relevant to sensitization and clinical AGS (≥0.35, ≥0.54, ≥2.0, and ≥5.5 kIU/L).
Results:
At the single center, 24 patients had sIgE ≥0.10 kIU/L; 11 (45.8%) confirmed AGS. Only 3 of 24 (12.5%) had a documented ABO group. In the TriNetX cohort, 9003 patients met the primary sensitization threshold; 1648 (18.3%) had ABO typing. Sensitivity analyses at higher thresholds confirmed over 80% of sensitized patients lacked ABO testing. Among sensitized patients, 211 were identified with both ABO group and transfusion history.
Conclusions:
Most α-Gal-sensitized patients lack documented ABO type, representing a possible gap in TRAGS preparedness. Allergy-Transfusion Medicine collaboration when α-Gal sensitization is identified may facilitate preemptive ABO typing and transfusion risk stratification.
