{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:57:20Z","timestamp":1792799840868,"version":"4.5.0"},"reference-count":31,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:00:00Z","timestamp":1774656000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:00:00Z","timestamp":1774656000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["U01AI181927"],"award-info":[{"award-number":["U01AI181927"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Transfusion\u2010related alpha\u2010gal syndrome (TRAGS) has recently been proposed as a cause of allergic transfusion reactions (ATRs) in which alpha\u2010gal\u2010specific IgE in sensitized group O (or potentially group A) recipients reacts with epitopes on group B or AB plasma\u2010containing components. Fewer than 10 cases have been reported, all from the Northeast and mid\u2010Atlantic United States, and alpha\u2010gal\u2013specific ATR evaluation practices are unstudied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design and Methods<\/jats:title>\n                    <jats:p>Two patients with ATRs consistent with TRAGS at a large academic medical center in Nashville, Tennessee are reported alongside a 5\u2010year retrospective cohort analysis of group O and A recipients experiencing ATRs following transfusion of group B or AB plasma\u2010containing products. Alpha\u2010gal IgE testing, AGS diagnosis documentation, and documented consideration of IgA deficiency were assessed for each qualifying reaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both index patients had pre\u2010existing AGS diagnoses unrecognized at component selection; one was a 42\u2010year\u2010old female and the second an 83\u2010year\u2010old male. Among 50 qualifying ATRs in 44 patients, including 13 severe or anaphylactic reactions, alpha\u2010gal IgE testing was not performed for any event, and no patient had a documented AGS diagnosis. IgA deficiency was considered in eight patients (18%), yielding no diagnoses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>TRAGS occurs in the tick\u2010endemic southeastern United States across a broader demographic range than previously recognized. IgA deficiency, present in &lt;0.3% of the population, was considered in 18% of qualifying patients while alpha\u2010gal sensitization, affecting 20%\u201330% in this region, was investigated in none. Integration of AGS history into pre\u2010transfusion risk assessment and ATR evaluation protocols is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/trf.70196","type":"journal-article","created":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T08:40:04Z","timestamp":1774687204000},"page":"1167-1179","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Transfusion\u2010related alpha\u2010gal syndrome: Two new cases expanding the demographic and geographic spectrum, and evidence of a diagnostic gap in allergic transfusion reaction evaluation"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7389-5161","authenticated-orcid":false,"given":"Mackenzie","family":"Foster","sequence":"first","affiliation":[{"name":"Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center  Nashville Tennessee 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