Defining risk factors and presentations of allergic reactions to platelet transfusion William J. Savage, MD, PhD, Robert G. Hamilton, PhD, DAMBLI, Aaron.

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Presentation transcript:

Defining risk factors and presentations of allergic reactions to platelet transfusion William J. Savage, MD, PhD, Robert G. Hamilton, PhD, DAMBLI, Aaron A.R. Tobian, MD, PhD, Ginger L. Milne, PhD, Richard M. Kaufman, MD, Jessica H. Savage, MD, MHS, P. Dayand Borge, MD, PhD, Paul M. Ness, MD Journal of Allergy and Clinical Immunology Volume 133, Issue 6, Pages 1772-1775.e9 (June 2014) DOI: 10.1016/j.jaci.2014.03.030 Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 Plasma concentrations of IgE are higher in platelet recipients who have ATRs, not donors. Phadiatop (A and B) and fx5 (C and D) were tested in platelet recipients who did and did not have a history of ATRs and platelet donors whose products did or did not cause an ATR. The reference line at 0.35 kUa/L indicates a likely clinically significant result. E, Platelet recipients' total IgE levels. F, The relationship between quartiles of Phadiatop concentration and the frequency of ATRs among platelet recipients (minimum 10 transfusions). Bars represent median values. Tx, Transfusion. Journal of Allergy and Clinical Immunology 2014 133, 1772-1775.e9DOI: (10.1016/j.jaci.2014.03.030) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E1 A typical urticarial transfusion reaction. Journal of Allergy and Clinical Immunology 2014 133, 1772-1775.e9DOI: (10.1016/j.jaci.2014.03.030) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E2 Validation of IgE results in the Trial to Reduce Alloimmunization to Platelets (TRAP). “Severe urticarial reactions” (n = 31) were prospectively recorded in 8769 platelet transfusions in TRAP. Archived baseline samples were tested for total IgE (A) and Phadiatop (B). The reference line at 0.35 kUa/L indicates a likely clinically significant Phadiatop test. Journal of Allergy and Clinical Immunology 2014 133, 1772-1775.e9DOI: (10.1016/j.jaci.2014.03.030) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E3 ATR incidence decreases with increasing transfusion number. Platelet transfusions for subjects with complete platelet transfusion histories (n = 120) were categorized into bins of 5 transfusions. The incidence of ATRs in each bin was calculated. Numbers above indicate the number of platelet transfusions in each bin. Journal of Allergy and Clinical Immunology 2014 133, 1772-1775.e9DOI: (10.1016/j.jaci.2014.03.030) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E4 Total tryptase level increases with more severe ATRs. Plasma total tryptase level was measured before and 25 to 90 minutes after an ATR. Concentrations are presented as the change in total tryptase level. The reference line at 2 ng/mL indicates a threshold for clinically relevant change. Journal of Allergy and Clinical Immunology 2014 133, 1772-1775.e9DOI: (10.1016/j.jaci.2014.03.030) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E5 Urinary eicosanoid metabolites are increased in ATRs. Urine PGE-M (A), tetranor PGD-M (B), PGD-M (C), and LTE4 (D) were measured at baseline and 3 to 6 hours after transfusion in 2 control platelet transfusions without an ATR, 4 subjects with urticarial reactions, and 2 subjects with urticaria and angioedema. Fold changes in metabolite levels after transfusion are shown. PGD-M and PGE-M results were not available for ATR “Urticaria 4.” LT, Leukotriene. Journal of Allergy and Clinical Immunology 2014 133, 1772-1775.e9DOI: (10.1016/j.jaci.2014.03.030) Copyright © 2014 American Academy of Allergy, Asthma & Immunology Terms and Conditions