A 69-year-old woman with rheumatoid arthritis was given a transfusion of a bag of red cell concentrate in mannitol-adenine-phosphate solution (RC-MAP) to improve anemia before she received an operation for gall bladder cancer. About 30 minutes after the start of the transfusion, anaphylactic reactions consisting of chills, nausea, vomiting and hypotension developed. She was found to have selective IgA deficiency and elevated anti-IgA antibodies, suggesting that these adverse reactions had been triggered by immunological reactions between patient anti-IgA and transfused IgA in the RC-MAP. She was, however, given saline-washed RC-MAP without any side effects in the subsequent transfusion.
The content of plasma protein in RC-MAP is lower than that in whole blood (WB) or concentrated red cells (CRC), with a resultant lower incidence of non-hemolytic transfusion reactions. However, its IgA content was high enough to develop anaphylactic reactions in the patient. Sequential dilution-concentration washing of RC-MAP with saline was effective in preventing the reactions.

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We describe our experience with a 51 year-old Japanese male with hypereosinophilic syndrome and granulocytic sarcoma in whom anaphylaxis had developed several times after transfusions of platelet concentrates. Electric charge of leukocyte-reduction filters or eosionophil counts in the peripheral blood did not show any relationship with anaphylaxis in this patient. Antibodies against IgA2m (1) and C9 were identified by western blotting analysis, but deficiency of IgA2 subclasses or C9 was not detected. These antibodies remain to be studied in regard with transfusion-related anaphylaxis. Because the cause of anaphylaxis following platelet transfusion has not been elucidated in most instances, it should be studied in individual cases to prevent this adverse effect in patients requiring transfusions.

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