Abstract
Non-haemolytic transfusion reactions are the most common type of transfusion reaction and include transfusion-related acute lung injury, transfusion-associated circulatory overload, allergic reactions, febrile reactions, post-transfusion purpura and graft-versus- host disease. Although life-threatening anaphylaxis occurs rarely, allergic reactions occur most frequently. If possible, even mild transfusion reactions should be avoided because they add to patients' existing suffering. During the last decade, several new discoveries have been made in the field of allergic diseases and transfusion medicine. First, mast cells are not the only cells that are key players in allergic diseases, particularly in the murine immune system. Second, it has been suggested that immunologically active undigested or digested food allergens in a donor's blood may be transferred to a recipient who is allergic to these antigens, causing anaphylaxis. Third, washed platelets have been shown to be effective for preventing allergic transfusion reactions, although substantial numbers of platelets are lost during washing procedures, and platelet recovery after transfusion may not be equivalent to that with unwashed platelets. This review describes allergic transfusion reactions, including the above-mentioned points, and focusses on their incidence, pathogenesis, laboratory tests, prevention and treatment.
Highlights
Winters et al (2004) reviewed 22 apheresis PC transfusions derived from four IgA-deficient donors with IgA antibodies and observed no allergic reactions
Plasma-reduced PLTs and washed PLTs. It remains unknown whether allergic reactions after PLT transfusions are caused by plasma proteins and their associated antibodies or biological response modifiers (BRMs), it has been noted that decreased amounts of plasma decreases the risk of allergic reactions
Plasma protein deficiencies and antibodies are not always evaluated in cases of allergic reactions. They are rarely identified; the cause of the allergic reaction is not specified and the causative relationship between the reaction and the transfusion remains obscure in many cases
Summary
The allergens that cause allergic transfusion reactions are plasma proteins such as IgA (Vyas et al, 1968; Schmidt et al, 1969; Sandler et al, 1995) and haptoglobin (Hp) (Koda et al, 2000; Shimada et al, 2002). In another study, Winters et al (2004) reviewed 22 apheresis PC transfusions derived from four IgA-deficient donors with IgA antibodies and observed no allergic reactions. The risk of immediate-type allergic reactions elicited by passive transfusion of plasma protein antibodies appears to be very low.
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