Abstract Background Transfusion‐related‐alpha‐gal syndrome (TRAGS) is an emerging transfusion complication in which alpha‐gal (α‐Gal)‐sensitized recipients may experience allergic reactions to B antigen‐containing plasma‐rich blood products. Group O recipients appear to be at greatest risk; group A recipients may also be at risk, whereas group B/AB individuals appear relatively protected in most studies. Identifying at‐risk patients requires both knowledge of α‐Gal sensitization status and ABO blood group, yet ABO typing among sensitized patients is poorly characterized. Study Design and Methods We retrospectively reviewed alpha‐gal‐specific IgE (sIgE) tests performed at an academic center in Madison, Wisconsin (2015–2026), assessing documented ABO blood group among patients with sIgE ≥0.10 kIU/L, and reviewing alpha‐gal syndrome (AGS) diagnosis, transfusion history, and transfusion reactions. Findings were validated using TriNetX, a federated Network of de‐identified U.S. electronic health records, with sensitivity analyses at published sIgE thresholds relevant to sensitization and clinical AGS (≥0.35, ≥0.54, ≥2.0, and ≥5.5 kIU/L). Results At the single center, 24 patients had sIgE ≥0.10 kIU/L; 11 (45.8%) confirmed AGS. Only 3 of 24 (12.5%) had a documented ABO group. In the TriNetX cohort, 9003 patients met the primary sensitization threshold; 1648 (18.3%) had ABO typing. Sensitivity analyses at higher thresholds confirmed over 80% of sensitized patients lacked ABO testing. Among sensitized patients, 211 were identified with both ABO group and transfusion history. Conclusions Most α‐Gal‐sensitized patients lack documented ABO type, representing a possible gap in TRAGS preparedness. Allergy‐Transfusion Medicine collaboration when α‐Gal sensitization is identified may facilitate preemptive ABO typing and transfusion risk stratification.
Abstract Background Therapeutic plasma exchange (TPE) is a procedure done for a broad variety of indications in which plasma proteins, including immunoglobulins, are removed. Current literature evaluating the risk of infection following TPE is limited to small single center studies, specific care contexts, or single indications. Methods We conducted a descriptive retrospective cohort study using the TriNetX federated EHR network. Patients who underwent TPE were identified. Those with qualifying infection codes 30 days or 7 days prior to their TPE procedure were excluded. The primary outcome was a composite of “any serious infections” within 30 days of the index TPE, with further analysis of five individual infection types. Opportunistic fungal infections were also assessed. Results Among 22,993 patients, the composite 30‐day proportion of infection following TPE was 6.3% (95% CI, 6.0%–6.6%), with the most common infections being sepsis at 2.2% (95% CI, 2.1–2.4), pneumonia at 2.0% (95% CI, 1.9–2.2), and urinary tract infection at 2.3% (95% CI, 2.1–2.5). Findings were consistent in sensitivity analyses using a 7‐day washout and by era of index TPE. The opportunistic fungal infection proportion at 30 days was infrequent, 1.1% (95% CI, 1.0–1.2). Kaplan–Meier analysis did not show pronounced peri‐procedural clustering. Conclusion These hypothesis generating findings in a large cohort of over 22,000 patients covering various indications across multiple care settings are roughly consistent with prior literature and indicate further studies with comparator groups are needed to clarify whether TPE independently increases infection risk.
