Severe allergic transfusion reactions to group B/AB plasma or platelets in group O recipients are linked to α-Gal sensitization

Abstract

Allergic transfusion reactions (ATR) are potentially lethal adverse events that occur in ∼0.3% to 6% of plasma or platelet transfusions. The main mechanism described is an immunoglobulin E (IgE)–mediated response to donor proteins, such as IgA and haptoglobin in deficient patients. Recently, in a nationwide retrospective observational study, we reported that group O recipients of group B or AB platelet concentrates or plasma were at significantly higher risk of severe ATR than recipients with other ABO combinations. Given the antigenic proximity between group B determinant and the galactose-α-1,3-galactose (α-Gal) epitope, we hypothesize a role for α-Gal IgE–mediated sensitization in these ATR. In this report, we investigated the presence of anti–α-Gal IgE in a cohort of 59 patients with severe ATR. We found that group O recipients of group B or AB blood components (plasma or platelet concentrates) were substantially more likely to exhibit high titers of group B cross-reactive anti–α-Gal IgE than other patients, supporting our hypothesis that α-Gal sensitization underlies these severe ATR. These findings suggest that α-Gal sensitization is an additional mechanism responsible for ATR in major ABO-incompatible transfusion and should be systematically explored in group O patients having received group B/AB plasma or platelets.