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Active transmission of urticaria by blood transfusion
ACTIVE
TRANSMISSION
OF URTICARIA
BY
BLOOD
TRANSFUSION MILO
K. TEDSTROM, B.S., M.D. SANTA ANA,
CALIF.
N AN excellent review of reactions to blood transfusions, Polayes and Ledererl state that allergic reactions to blood transfusion are not uncommon. Duke2 in a review of 700 transfusions says that a history of allergic phenomena in an individual is an important contraindication to his use as a donor. A search of the literature does not reveal any reports of the active transmission of urticaria by blood transfusion. The following case report thus seems to be of considerable interest,. A male, aged twenty-eight years, whose occupation was given as a laborer, was fatally ill wi.th acute aplastic anemia, apparently secondary to chronic benzol poisoning. A series of thirteen whole blood transfusions was given him over a period of four weeks. Repeated frequent transfusions were necessary because of continuous bleeding from gum margins, kidneys, and gastrointestinal tract. The patient belonged to group three, and all donors used belonged to the same group. In addition, each donor was cross-matched with the recipient and a perfect match resul.ted in each instance. For the seventh transfusion, a brother-in-law of the patient was selected. About thirty minutes following the transfusion, consisting of 500 C.C. of whole blood given by the direct method, the recipient developed a generalized The urticaria and urticaria accompanied by very intense pruritus. itching were both relieved by adrenalin hypodermically. Subsequent questioning of the donor revealed that he had had generalized hives He was sensitive to strawberries, and at the time of the transfusion. the urticaria had developed following ingestion of these berries. The recipient had no history of previous allergic phenomena, and later he About two was given strawberries without developing urticaria. weeks later this patient received his twelfth transfusion, and his brother-in-law was again used as the donor. The donor did not exhibit urticarial phenomena at the time, and no hives developed in the recipient following this transfusion which was conducted under the identical conditions of the previous transfusion. Passive transmission of human hypersensitiveness by blood transfusion was first observed by R,amirez.3 The donor was an asthmatic individual sensitive to horse dander. The recipient subsequently had asthmatic attacks when he came in contact with horse dander. ReI
303
304
THE
JOURNAL
OF
ALLERGY
cently Holder and Diefenboch4 have also reported its occurrence following a whole blood transfusion. Their patient was ill with agranulocytopenia and received two transfusions along with other therapy. Following her discharge from the hospital she had several attacks of urticaria, which she had never previously experienced, following ingestion of strawberries. Subsequent questioning of the second donor revealed that he had had violent urticarial reactions following eating of strawberries all his life. Duke and Stofer5 have reported allergic reactions developing in sensitive persons who were transfused with the blood of donors who had previously ingested substances to which the recipients were sensitive. To prevent such reactions Brem, Zeiler and Hammack” have emphasized the importance of using fasting donors. Bijttner7 has reported several instances of allergic reactions developing after repeated transfusions of compatible blood. The reactions developed following those transfusions that were done three to six weeks after the first. Smyths has reported immediate wheal formation at the site of injection following intracutaneous injection of serum from certain infants with active eczema into the skin of normal infants. He considers the reaction to be due to the transfer of an irritating substance circulating in the blood of the eczema patient. This irritant resembles the “histamine-like ” substance described by Lewis and Grant.” In the case reported above, it seems likely that the specific substance responsible for the production of hives in the recipient was circulating in the donor’s blood stream at the time of the transfusion and thus After being acquired by him, a was transmitted to the recipient. generalized urticarial reaction followed. COXCLUSIONS
1. The case report of a patient who developed active urticaria following direct transfusion of whole blood from a donor who was suffering with urticaria is presented. 2. The urticaria was undoubtedly due to the transmission by the transfusion of the active substance in the blood responsible for producing urticaria originally in the donor. 3. This substance is probably the “histamine-like” substance of Lewis. 4. Greater care should be exercised in investigating the allergic history of all prospective donors. REFERENCES
Reactions 1. Polayes, S. H., and Lederer, M.: Clin. Med. 17: 1029, 1932. 2. Duke, W. W.: Transfusion in Treatment 1926.
to of
Blood
Anemia,
Transfusion, J.
MO.
J. M.
A.
Lab. 23:
& 371,
TEDSTROM:
TRANSMISSION
OF
URTICARIA
BY
BLOOD
TRANSFUSION
305
3. Ramirez, M. A.: Horse Asthma Following Blood Transfusion, J. A. M. A. 73: 984, 1919. 4. Holder, H. G., and Diefertboch, W. E.: Urticaria-Its Passive Transmission by Blood Transfusion, Ca.lif. & Western Med. 37: 387, 1932. 5. Duke, W. W., and Stofer, D. D.: Severe Case of Allergy Due to Fish Glue, M. Clin. North America 7: 1253. 1924. 6. Brem, W. Y., Zeiler, A. H., a& Hammaek, R. W.: Use of Fasting Donors in Blood Transfusions, Am. J. M. SC. 175: 96, 1928. Anaphyl&ie in Blood Transfusions, Deutsche med. Wchnschr. 50: 7. Bijttner, A.: 599, 1924. Quoted by Polayes and Lederer, ref. 1. The Toxic Fraction in Certain Eczema, Serums, J. ALLERGY 2: 8. Smyth, F. S.: 173, 1931. Vascular Reactions of Skin to Injury; Anaphylactie 9. Lewis, T., and Grant, R,. T.: Skin Reaction, Heart :L3: 219, 1926.
TRANSMISSION
OF URTICARIA
BY
BLOOD
TRANSFUSION MILO
K. TEDSTROM, B.S., M.D. SANTA ANA,
CALIF.
N AN excellent review of reactions to blood transfusions, Polayes and Ledererl state that allergic reactions to blood transfusion are not uncommon. Duke2 in a review of 700 transfusions says that a history of allergic phenomena in an individual is an important contraindication to his use as a donor. A search of the literature does not reveal any reports of the active transmission of urticaria by blood transfusion. The following case report thus seems to be of considerable interest,. A male, aged twenty-eight years, whose occupation was given as a laborer, was fatally ill wi.th acute aplastic anemia, apparently secondary to chronic benzol poisoning. A series of thirteen whole blood transfusions was given him over a period of four weeks. Repeated frequent transfusions were necessary because of continuous bleeding from gum margins, kidneys, and gastrointestinal tract. The patient belonged to group three, and all donors used belonged to the same group. In addition, each donor was cross-matched with the recipient and a perfect match resul.ted in each instance. For the seventh transfusion, a brother-in-law of the patient was selected. About thirty minutes following the transfusion, consisting of 500 C.C. of whole blood given by the direct method, the recipient developed a generalized The urticaria and urticaria accompanied by very intense pruritus. itching were both relieved by adrenalin hypodermically. Subsequent questioning of the donor revealed that he had had generalized hives He was sensitive to strawberries, and at the time of the transfusion. the urticaria had developed following ingestion of these berries. The recipient had no history of previous allergic phenomena, and later he About two was given strawberries without developing urticaria. weeks later this patient received his twelfth transfusion, and his brother-in-law was again used as the donor. The donor did not exhibit urticarial phenomena at the time, and no hives developed in the recipient following this transfusion which was conducted under the identical conditions of the previous transfusion. Passive transmission of human hypersensitiveness by blood transfusion was first observed by R,amirez.3 The donor was an asthmatic individual sensitive to horse dander. The recipient subsequently had asthmatic attacks when he came in contact with horse dander. ReI
303
304
THE
JOURNAL
OF
ALLERGY
cently Holder and Diefenboch4 have also reported its occurrence following a whole blood transfusion. Their patient was ill with agranulocytopenia and received two transfusions along with other therapy. Following her discharge from the hospital she had several attacks of urticaria, which she had never previously experienced, following ingestion of strawberries. Subsequent questioning of the second donor revealed that he had had violent urticarial reactions following eating of strawberries all his life. Duke and Stofer5 have reported allergic reactions developing in sensitive persons who were transfused with the blood of donors who had previously ingested substances to which the recipients were sensitive. To prevent such reactions Brem, Zeiler and Hammack” have emphasized the importance of using fasting donors. Bijttner7 has reported several instances of allergic reactions developing after repeated transfusions of compatible blood. The reactions developed following those transfusions that were done three to six weeks after the first. Smyths has reported immediate wheal formation at the site of injection following intracutaneous injection of serum from certain infants with active eczema into the skin of normal infants. He considers the reaction to be due to the transfer of an irritating substance circulating in the blood of the eczema patient. This irritant resembles the “histamine-like ” substance described by Lewis and Grant.” In the case reported above, it seems likely that the specific substance responsible for the production of hives in the recipient was circulating in the donor’s blood stream at the time of the transfusion and thus After being acquired by him, a was transmitted to the recipient. generalized urticarial reaction followed. COXCLUSIONS
1. The case report of a patient who developed active urticaria following direct transfusion of whole blood from a donor who was suffering with urticaria is presented. 2. The urticaria was undoubtedly due to the transmission by the transfusion of the active substance in the blood responsible for producing urticaria originally in the donor. 3. This substance is probably the “histamine-like” substance of Lewis. 4. Greater care should be exercised in investigating the allergic history of all prospective donors. REFERENCES
Reactions 1. Polayes, S. H., and Lederer, M.: Clin. Med. 17: 1029, 1932. 2. Duke, W. W.: Transfusion in Treatment 1926.
to of
Blood
Anemia,
Transfusion, J.
MO.
J. M.
A.
Lab. 23:
& 371,
TEDSTROM:
TRANSMISSION
OF
URTICARIA
BY
BLOOD
TRANSFUSION
305
3. Ramirez, M. A.: Horse Asthma Following Blood Transfusion, J. A. M. A. 73: 984, 1919. 4. Holder, H. G., and Diefertboch, W. E.: Urticaria-Its Passive Transmission by Blood Transfusion, Ca.lif. & Western Med. 37: 387, 1932. 5. Duke, W. W., and Stofer, D. D.: Severe Case of Allergy Due to Fish Glue, M. Clin. North America 7: 1253. 1924. 6. Brem, W. Y., Zeiler, A. H., a& Hammaek, R. W.: Use of Fasting Donors in Blood Transfusions, Am. J. M. SC. 175: 96, 1928. Anaphyl&ie in Blood Transfusions, Deutsche med. Wchnschr. 50: 7. Bijttner, A.: 599, 1924. Quoted by Polayes and Lederer, ref. 1. The Toxic Fraction in Certain Eczema, Serums, J. ALLERGY 2: 8. Smyth, F. S.: 173, 1931. Vascular Reactions of Skin to Injury; Anaphylactie 9. Lewis, T., and Grant, R,. T.: Skin Reaction, Heart :L3: 219, 1926.