ISSN: 2961 - 4295
Recurrent IgE-Mediated Anaphylactic Transfusion Reactions with Normal IgA in a 98-Year-Old Woman: A Transfusion-Sparing Approach.
Khaled Abdulrahman Ali Alshehri¹, Saud Musaed Omar Alsammahi², Sarah Abdullah Sulaiman Alharby³, Abdullah Hameed Alsehli⁴
DOI:10.64039/djms.2026.2301We report a 98-year-old morbidly obese woman with severe iron deficiency anemia (hemoglobin 59 g/L) and multiple comorbidities who developed two consecutive severe anaphylactic reactions to ABO-compatible packed red blood cells, occurring within 10–30 minutes of transfusion and requiring intramuscular epinephrine. Serum IgA was normal, total IgE was elevated (444 IU/mL), and there was no biochemical evidence of hemolysis, supporting an IgE-mediated, non–IgA-related mechanism. Further transfusion was avoided. A transfusion-sparing strategy using intravenous ferric carboxymaltose combined with darbepoetin alfa normalized hemoglobin to 122 g/L within four weeks. This case shows that a normal serum IgA does not exclude an anaphylactic transfusion reaction and that high-dose intravenous iron with an erythropoiesis-stimulating agent is an effective, life-saving alternative in elderly, multi-morbid patients with transfusion hypersensitivity.
