A Patient With a Low IgA Level Requiring Transfusion During CABG Surgery

Gifford Lum, MD; Paula Szuflad, MS, MT(ASCP)SBB; Michael D'Amarino, MT(ASCP)BB

Disclosures

Lab Med. 2005;36(6):353-356. 

In This Article

Overview and Introduction

Patient: 71-year-old Caucasian man.
Chief Complaint: Bradycardia.
History of Present Illness: Patient was admitted to the medical service with asymptomatic bradycardia (heart rates between 33 and 55 beats/minute). Results of cardiac catheterization showed 2-vessel disease with 90% focal stenosis of the mid- and 40% stenosis of the distal-left main coronary artery and 95% stenosis of the mid-left anterior descending coronary artery. The right coronary artery, showed a proximal lesion and 50% stenosis, while the posterior descending coronary artery showed focal stenosis (70%). The patient was referred for coronary artery bypass graft (CABG) surgery.
Prior Medical History: The patient had a history of stroke with leftside hemiparesis; impotence, secondary to vascular insufficiency; deep vein thrombosis and pulmonary embolism with placement of a Greenfield filter; anemia from chronic disease; and benign prostatic hyperplasia.
Principal Laboratory Findings ( Table 1 ):
Additional Diagnostic Procedures: Coronary artery bypass graft surgery was recommended for this patient because of severe 2-vessel coronary artery disease. Because of the possibility of an anaphylactic transfusion reaction, the blood bank was consulted regarding blood product availability. A sample of the patient's blood was submitted to the American Red Cross (ARC) Reference Laboratory for IgA testing, using a more sensitive assay than immunonephelometry, and testing for anti-IgA antibodies. Before results for these tests were available, however, surgeons elected to perform CABG surgery on this patient. The patient was transfused with 2 units of washed RBCs during surgery without incident. In addition, 1 unit of IgA-deficient fresh frozen plasma (FFP) was procured from the ARC and its American Rare Donor Program, and a procedure for washing platelet units was set up in the blood bank. The patient did not require administration of FFP or platelet units. After the CABG surgery had been performed, the IgA (>0.05 mg/dL, but <6.7 mg/dL) and anti-IgA (negative) results were received from the ARC Reference Laboratory.

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