dawnmedDawnMed Journal of Medical ScienceISVolume 2, Issue 3MultidisciplinaryEnglish2026NNY2026079Internal MedicineRecurrent IgE-Mediated Anaphylactic Transfusion Reactions with Normal IgA in a 98-Year-Old Woman: A Transfusion-Sparing Approach.EnglishY16Khaled Abdulrahman AliAlshehri¹EnglishNSaud Musaed OmarAlsammahi²EnglishYSarah Abdullah SulaimanAlharby³EnglishYAbdullah HameedAlsehli⁴EnglishY10.64039/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.EnglishAnaphylactic transfusion reaction, Iron deficiency anemia, IgE-mediated hypersensitivity, Non-IgA anaphylaxishttps://dawnmed.com.sa/abstract?id=19References16191. Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;372(19):1832and;ndash;1843. doi:10.1056/NEJMra1401038. PMID: 25946282.2. Hirayama F. Current understanding of allergic transfusion reactions: incidence, pathogenesis, laboratory tests, prevention and treatment. Br J Haematol. 2013;160(4):434and;ndash;444. doi:10.1111/bjh.12150. PMID: 23215650.3. Erikstein BS, Alnand;aelig;s MB, Apelseth TO. Blood transfusion-associated anaphylaxis in perioperative- and non-perioperative patients in Western Norway 2002and;ndash;2021. Blood Transfus. 2024;22(6):502and;ndash;513. doi:10.2450/BloodTransfus.738. PMID: 38814882.4. Savage WJ, Tobian AAR, Savage JH, Wood RA, Schroeder JT, Ness PM. Scratching the surface of allergic transfusion reactions. Transfusion. 2013;53(6):1361and;ndash;1371. doi:10.1111/j.1537-2995.2012.03892.x. PMID: 22998777.5. Salvadori U, Sandri M, Melli C, Polese F, Simeoni M, Capelli S, et al. Ferric carboxymaltose reduces the number of red blood cell units transfused and allows transfusion independence to be obtained in patients with iron deficiency anemia secondary to gastrointestinal chronic blood loss. Transfusion. 2016;56(11):2720and;ndash;2726. doi:10.1111/trf.13794. PMID: 27600706.6. Sandler SG, Eder AF, Goldman M, Winters JL. The entity of immunoglobulin A-related anaphylactic transfusion reactions is not evidence based. Transfusion. 2015;55(1):199and;ndash;204. doi:10.1111/trf.12796. PMID: 25066014.7. Tacquard C, Boudjedir K, Carlier M, Muller JY, Gomis P, Mertes PM. Hypersensitivity transfusion reactions due to IgA deficiency are rare according to French hemovigilance data. J Allergy Clin Immunol. 2017;140(3):884and;ndash;885. doi:10.1016/j.jaci.2017.03.029. PMID: 28414063.8. Shimada E, Tadokoro K, Watanabe Y, Ikeda K, Niihara H, Maeda I, et al. Anaphylactic transfusion reactions in haptoglobin-deficient patients with IgE and IgG haptoglobin antibodies. Transfusion. 2002;42(6):766and;ndash;773. doi:10.1046/j.1537-2995.2002.00117.x. PMID: 12147031.9. Jacobs JFM, Baumert JL, Brons PP, Joosten I, Koppelman SJ, van Pampus ECM. Anaphylaxis from passive transfer of peanut allergen in a blood product. N Engl J Med. 2011;364(20):1981and;ndash;1982. doi:10.1056/NEJMc1101692. PMID: 21591965.10. Savage WJ, Tobian AA, Savage JH, Hamilton RG, Ness PM. Atopic predisposition of recipients in allergic transfusion reactions to apheresis platelets. Transfusion. 2011;51(11):2337and;ndash;2342. doi:10.1111/j.1537-2995.2011.03160.x. PMID: 21569041.11. Tinegate H, Birchall J, Gray A, Haggas R, Massey E, Norfolk D, et al. Guideline on the investigation and management of acute transfusion reactions. Br J Haematol. 2012;159(2):143and;ndash;153. doi:10.1111/bjh.12017. PMID: 22928769.12. Tobian AAR, Savage WJ, Tisch DJ, Thoman S, King KE, Ness PM. Prevention of allergic transfusion reactions to platelets and red blood cells through plasma reduction. Transfusion. 2011;51(8):1676and;ndash;1683. doi:10.1111/j.1537-2995.2010.03008.x. PMID: 21214585.13. Scott LJ. Ferric carboxymaltose: a review in iron deficiency. Drugs. 2018;78(4):479and;ndash;493. doi:10.1007/s40265-018-0885-7. PMID: 29532438.