Caitlin Raymond: Understanding IgA Deficiency and Anaphylaxis Risk
Caitlin Raymond, a board-certified Clinical Pathologist and current Transfusion Medicine Fellow at the National Institutes of Health, shared a post on LinkedIn:
“Somewhere in a chart, someone typed IgA deficient.
No level.
No reaction history.
Just the label.
And because the label exists, every transfusion from here on is ordered as washed red cells and IgA-deficient plasma.
But do we actually know what were protecting against?
- Immunology defines selective IgA deficiency as under 7 mg/dL. Transfusion medicine uses under 0.05 mg/dL, confirmed by a send-out assay. Those are very different populations.
- Roughly 20 to 40% of IgA-deficient patients develop anti-IgA, yet donor studies show no increase in reactions in recipients of anti-IgA-containing components.
- Anti-IgA is estimated to account for only a small fraction of anaphylactic transfusion reactions.
- Canadian Blood Services recommends testing after a documented severe reaction, not as a prophylactic screen.
Our ordering habits are more conservative than the guidance.
I don’t think the evidence was ignored.
I think it never quite dispersed a caution built into practice decades ago, and nobody circled back to ask whether that caution still fits.
Next time IgA deficient shows up with no further detail, is did we wash the cells the right question?
What does your blood bank do when the label is all you have?”
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