A 70-year-old woman develops urticaria, angioedema, and bronchospasm immediately after starting a unit of packed red blood cells. She has a known history of IgA deficiency. What is the most appropriate management for future transfusions?
- A Premedicate with antihistamines and corticosteroids
- B Use leukodepleted blood products only
- C Use washed red blood cells or IgA-deficient donor blood ✓
- D Avoid all future transfusions; use erythropoietin instead
Correct answer: C. Use washed red blood cells or IgA-deficient donor blood
Explanation
Patients with IgA deficiency can develop anti-IgA antibodies and experience anaphylactic reactions upon exposure to IgA in blood products. Management includes washed red blood cells (to remove plasma containing IgA) or blood from IgA-deficient donors. Premedication is insufficient for anaphylaxis prevention. Leukodepletion does not address IgA content. This is a distinct mechanism from simple allergic (urticarial) reactions which respond to antihistamines.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.