Salama Abdulgabar, Temmesfeld Bettina, Hippenstiel Stefan, Kalus Ulrich, Suttorp Norbert, Kiesewetter Holger
Institute for Transfusion Medicine and Internal Medicine, Department of Infectious Diseases, University Clinic Charité, Berlin, Germany.
Transfusion. 2004 Apr;44(4):509-11. doi: 10.1111/j.1537-2995.2004.03316.x.
Management of patients with clinically significant anti-IgA is difficult and unsatisfactory in many aspects.
A 40-year-old man with common variable immunodeficiency had a previous history of anaphylaxis after an intramuscular immunoglobulin administration. His serum contained anti-IgA, and he required immunoglobulins for recurrent infections.
The administration of intravenous immunoglobulins (IVIgG) containing less than 0.1 mg per mL IgA led to an anaphylactic reaction after the transfusion of only 2 to 3 mL. The same IVIgG charge was subsequently pretreated with freshly separated autologous plasma and given to the patient on three consecutive days without any reaction (1.25, 10, and 10 g each in 400 mL plasma). Anti-IgA activity did not increase, and the patient was treated again without complications.
Ex vivo pretreatment of IVIgG preparations with autologous plasma appears to be safe and useful in the management of patients with clinically significant anti-IgA. To achieve a significant IgA blockage, the preparation to be used should not contain large amounts of IgA.
The strategy described here appears to be safe and may help prevent anaphylaxis in many instances.
对具有临床显著意义的抗IgA患者的管理在许多方面都很困难且不尽人意。
一名40岁患有常见变异型免疫缺陷的男性，既往有肌肉注射免疫球蛋白后发生过敏反应的病史。他的血清中含有抗IgA，且因反复感染需要免疫球蛋白治疗。
输注每毫升含IgA少于0.1毫克的静脉注射免疫球蛋白（IVIgG），仅输注2至3毫升后就引发了过敏反应。随后，相同剂量的IVIgG用新鲜分离的自体血浆进行预处理，并连续三天给予该患者，未出现任何反应（分别在400毫升血浆中加入1.25克、10克和10克）。抗IgA活性未增加，且该患者再次接受治疗时未出现并发症。
用自体血浆对IVIgG制剂进行体外预处理，在管理具有临床显著意义的抗IgA患者方面似乎是安全且有用的。为实现显著的IgA阻断，所使用的制剂不应含有大量IgA。
此处描述的策略似乎是安全的，并且在许多情况下可能有助于预防过敏反应。
