{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T17:09:26Z","timestamp":1792343366693,"version":"4.4.0"},"reference-count":23,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The bites of certain tick species can induce galactose\u2010\u03b1\u20101,3\u2010galactose (alpha\u2010gal) IgE formation. Individuals with alpha\u2010gal IgE can become allergic to meat, a condition termed alpha\u2010gal syndrome. Alpha\u2010gal is structurally related to B antigen. Recent case reports (Gilstad et al., 2023 and Miller et al., 2024) suggest that transfusing group B plasma or platelets to group O individuals with alpha\u2010gal IgE can trigger severe allergic transfusion reactions. However, mechanistic evidence is lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design and Methods<\/jats:title>\n                    <jats:p>A 76\u2010year\u2010old group O man undergoing heart surgery became profoundly hypotensive after receiving 50\u2009mL of a group B platelet unit. He recovered with diphenhydramine treatment. We investigated potential causes of anaphylaxis (alpha\u2010gal syndrome; IgA deficiency; protamine, and rocuronium allergies). The platelet unit and patient samples were analyzed by flow cytometry. Indirect basophil activation tests (iBATs) were performed on the patient's plasma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The patient's serum tryptase level spiked, consistent with anaphylaxis. His serum tested positive for alpha\u2010gal IgE (1.49\u2009kU\/L). Flow cytometric analyses demonstrated that: (1) the transfused platelets expressed substantial B antigen, and (2) the patient's plasma contained IgE\u2010recognizing alpha\u2010gal and B antigen\u2009&gt;\u2009A antigen. In iBATs, resting allogeneic basophils incubated with the patient's plasma showed equivalent (albeit weak) activation when stimulated with either alpha\u2010gal or B antigen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>We report a case of anaphylactic shock in an O patient transfused with a B platelet unit. The in vitro data suggest, but do not prove, that the reaction was mediated by recipient alpha\u2010gal IgE. Further studies are needed to establish whether transfusion\u2010related alpha\u2010gal syndrome (\u201cTRAGS\u201d) is a true clinical entity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/trf.18405","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T14:48:46Z","timestamp":1757688526000},"page":"1989-1995","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Immunologic investigation of an allergic transfusion reaction suspected due to alpha\u2010gal syndrome"],"prefix":"10.1111","volume":"65","author":[{"given":"Victoria M.","family":"Jones","sequence":"first","affiliation":[{"name":"Department of Pathology Dartmouth Hitchcock Medical Center  Lebanon New Hampshire USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirotomo","family":"Nakahara","sequence":"additional","affiliation":[{"name":"Department of Pathology Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shailesh K.","family":"Choudhary","sequence":"additional","affiliation":[{"name":"Department of Medicine University of North Carolina School of Medicine  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8601-5438","authenticated-orcid":false,"given":"Nancy M.","family":"Dunbar","sequence":"additional","affiliation":[{"name":"Department of Pathology Dartmouth Hitchcock Medical Center  Lebanon New Hampshire USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2357-9564","authenticated-orcid":false,"given":"Zbigniew M.","family":"Szczepiorkowski","sequence":"additional","affiliation":[{"name":"Department of Pathology Dartmouth Hitchcock Medical Center  Lebanon New Hampshire USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora R.","family":"Ratcliffe","sequence":"additional","affiliation":[{"name":"Department of Pathology Dartmouth Hitchcock Medical Center  Lebanon New Hampshire USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Cervinski","sequence":"additional","affiliation":[{"name":"Department of Pathology Dartmouth Hitchcock Medical Center  Lebanon New Hampshire USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Yanik","sequence":"additional","affiliation":[{"name":"Department of Medicine Dartmouth Hitchcock Medical Center  Lebanon New Hampshire USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell","family":"Fuller","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Dartmouth Hitchcock Medical Center  Lebanon New Hampshire USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian C.","family":"Spence","sequence":"additional","affiliation":[{"name":"Department of 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