A 26-year-old primigravid woman at 36 weeks gestation is admitted to the hospital because of vaginal bleeding and lower abdominal pain. Her other medical problems include selective IgA deficiency, allergic rhinitis, and recurrent sinusitis. Her anti-IgA antibody screening is positive.
Evaluation reveals placental abruption. She is scheduled to undergo urgent cesarean section and requires blood transfusion.
Which of the following should be administered to this patient?

Question

A 26-year-old primigravid woman at 36 weeks gestation is admitted to the hospital because of vaginal bleeding and lower abdominal pain.  Her other medical problems include selective IgA deficiency, allergic rhinitis, and recurrent sinusitis.  Her anti-IgA antibody screening is positive.
Evaluation reveals placental abruption.  She is scheduled to undergo urgent cesarean section and requires blood transfusion.
Which of the following should be administered to this patient?

Quizplus · Accepted Answer

11ec193a_96b5_8aa5_853d_e381dd83eb21_MD0002_00 When red cells and plasma are separated from whole blood, small amounts of residual plasma remain in the red cell concentrate. This plasma contains proteins, including IgA. IgA deficient patients develop antibodies against IgA, which can react with IgA-containing donor products and induce an anaphylactic reaction. To reduce this risk, red cells should be washed to remove as much of the plasma as possible. (Choices B & C) Packed red cells can also be contaminated with leukocytes or leukocyte debris during the separation process. This can induce febrile transfusion reactions and HLA alloimmunization. Cytomegalovirus (CMV) also resides in the leukocytes and can be transmitted through transfusion. Thus, leukoreduction with filters to remove WBCs reduces the risk of HLA alloimmunization, febrile nonhemolytic transfusion reactions, and transmission of CMV. However, leukoreduction alone cannot remove all lymphocyte components. But, gamma radiation can essentially kill all the living lymphocytic components (T-lymphocytes). This is particularly useful in patients at risk for transfusion-associated graft-versus-host disease, a rare, but fatal complication caused by the engraftment and proliferation of donor T lymphocytes in the transfused recipient. (Choice A) Desensitization to HLA and ABO antigens is indicated for certain patients who are difficult to transfuse secondary to their broad immunogenicity. Educational objective: Patients with IgA deficiency should receive washed RBCs to remove as much plasma (containing IgA) as possible. Patients at risk for transfusion-associated graft-versus-host disease (e.g., bone marrow transplant) require irradiated RBCs. To reduce CMV transmission (e.g., patients waiting for transplant or those with AIDS), patients should receive leukoreduced RBCs. __________ References: Red blood cell transfusion in clinical practice. (http://www.ncbi.nlm.nih.gov/pubmed/17679019)

A 26-Year-Old Primigravid Woman at 36 Weeks Gestation Is Admitted