Review: IgA anaphylactic transfusion reactions. Part II. Clinical diagnosis and bedside management

Numerous published case reports of IgA-related anaphylactic transfusion reactions (1968-present) alert us that certain IgA-deficient persons are at risk for acute generalized transfusion reactions, presenting with severe shortness of breath. However, such IgA anaphylactic transfusion reactions are uncommon, and the majority of clinical diagnoses are not confirmed by detection of anti-IgA in the patient's plasma. The recognition of other transfusion-related acute generalized reactions in recent years requires expanding the differential diagnosis for such events to include other possible diagnoses, most importantly TRALI. Clinical diagnoses of IgA anaphylactic transfusion reactions should be followed up promptly by testing for anti-IgA. Failure to follow up a clinical diagnosis by testing for anti-IgA will complicate management of any future blood transfusions and potentially commit the patient to a lifelong requirement for highly specialized IgA-deficient blood products.