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Benefits and risks of IgA in immunoglobulin preparations.

作者信息

Nydegger Urs E, Fierz Walter, Risch Lorenz

机构信息

Labormedizinisches Zentrum Dr. Risch, Waldeggstrasse 37, CH-3097 Liebefeld bei Bern, Switzerland.

出版信息

Transfus Apher Sci. 2012 Feb;46(1):97-102. doi: 10.1016/j.transci.2011.11.014. Epub 2011 Dec 29.

DOI:10.1016/j.transci.2011.11.014
PMID:22209283
Abstract

The case of Immunoglobulin A (IgA) in transfusion medicine is unsettled: on one hand IgA is an important component of adaptive immunity and its deficiency may cause disease, on the other its presence in blood products might induce, in rare instances, allergy-like symptoms if not anaphylaxis. The practice with i.v. immunoglobulins currently changes as up to 10% concentrated preparations are given at fast rates hence even trace amounts of IgA contained in these IgG preparations can cause unexpected (side-) effects. Fortunately, the spectrum of sensitive IgA assays, along with anti-IgA screening assays now permits laboratories to narrow down IgA-dependent transfusion reactions to the real cases, in which IgA was the decisive trigger of anaphylaxis, proven or not by the presence of anti-IgA of the IgG or even IgE class. Tolerance to allogenic IgA has recently been reported. The known association of HLA with IgA deficiency (IgAD) has now been completed with an association to the nonsynonymous variant in IFHI1, allowing physicians to more precisely spot recipients at risk for an IgA-dependent transfusion reaction. Our review, along with our own experience here in Switzerland, allows us to conclude that IgA is a beneficial antibody rather than an allergen to be placed at the end of the list of non-infectious transfusion complications such as TRALI, febrile non-hemolytic reactions, purpura or volume overload.

摘要

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