The symptoms: The child was receiving a blood transfusion as a treatment for lymphoblastic leukemia, a type of blood cancer that originates in bone marrow, when he experienced a severe allergic reaction. His blood pressure dropped, and he developed a rash. Swelling appeared around his lips, tongue and eyelids, and he had difficulty breathing. This type of allergic response, known as anaphylaxis, can be life-threatening.
His doctors collected blood samples immediately after the reaction, and these contained unusually high levels of a type of protein called mast-cell tryptase, which is released by certain immune cells during anaphylaxis. However, the physicians were puzzled as to what had caused the extreme reaction, they wrote in a report of the case.
A protein in peanuts called Ara h2 is one of the main allergens that set off allergic reactions in people's immune systems. One of the building blocks of the allergen, called DRP-Ara h2, takes more than 24 hours to digest and remains capable of binding to receptors and triggering an allergic response throughout that time.
"These data are consistent with the hypothesis that the consumption of peanuts by the donors before blood donation provided the trigger for this patient's transfusion reaction," the doctors reported.
What makes the case unique: Allergic reactions during blood transfusions are rare, although estimates of their exact frequency vary. Some estimates suggest that they occur in about 0.001% to 0.006% of transfusions, while others find they occur in 0.1% of transfusions.
Other dilemmasThe triggers that set off these allergic responses are seldom identified. Prior to this case, other researchers suggested that blood transfusions could passively transfer food allergens from the donor to the recipient. Indeed, a growing body of evidence suggests that this may be more common than expected.
"It is possible that allergens transferred in blood products to other patients have led to reactions that have gone unexplained and unreported," the doctors wrote in the case report.
Can you guess the diagnosis in these strange medical cases? Find out with our diagnostic dilemma quiz!
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