Successful desensitization to immunoglobulin A in a case of transfusion‐related anaphylaxis

BACKGROUND: A history of anaphylaxis after transfusion of immunoglobulin A (IgA)‐containing blood products in selective IgA‐deficient (sIgAD) patients can be a major problem, particularly in emergencies, when large quantities of blood products are required. CASE REPORT: A 19‐year‐old woman with end‐stage Type 2 autoimmune hepatitis required liver transplantation as her only remaining treatment option. However, she also had sIgAD, anti‐IgA antibodies, and episodes of anaphylaxis after receiving IgA‐containing blood products. Liver transplantation would have been extremely challenging due to the difficulty of obtaining sufficient blood products from suitable IgA‐deficient donors. Hence, it became imperative to devise a protocol to desensitize her to IgA‐containing blood products. RESULTS: Using a continuous infusion of an IgA‐enriched (6 mg/mL IgA) immunoglobulin preparation with gradual increases in concentration, she was successfully desensitized to IgA. Consequently, she was able to receive standard platelets, fresh‐frozen plasma, and red blood cells with no complications. CONCLUSION: This approach could prove very useful in similar cases that may require administration of large quantities of blood products particularly in emergency lifesaving circumstances.     

Obturator dislocation of the hip with ipsilateral femoral neck fracture: A case report

Obturator dislocation of the hip associated with ipsilateral femoral neck fracture is an unusual injury. We report a case of a 40-year-old man with such a combination of injuries which was treated with an open reduction and internal fixation. He has a good follow-up result. There was no evidence of avascular necrosis on radiographs after 3 years.     

Helicobacter pylori infection in children: population‐based age‐specific prevalence and risk factors in a developing country

Aim: We estimated the prevalence, age of acquisition and risk factors for Helicobacter pylori (H. pylori) seroprevalence in children aged 1–15 years. Methods: Exposure was assessed using ELISA. Parents responded to a questionnaire regarding number of individuals sharing house, rooms, water source, latrines, housing and assessment of socioeconomic status (SES) by Hollingshead Index. Results: Serum of 1976 children was tested. Helicobacter pylori seropositivity in children aged 11–15 years was 53.5% (OR: 2.0, 95% CI: 1.58–2.5). It increased with moderate crowding index (CRI) of 2–4 to 45.9% (OR: 1.23, 95% CI: 0.92–1.63) and to 51.2% with CRI >4 (OR: 1.52, 95% CI: 1.12–2.06). In middle SES, seropositivity was 50.5% (331/655) (OR: 1.7, 95% CI: 1.29–2.35), whereas in lower SES, it was 47.1% (500/1062) (OR: 1.5, 95% CI: 1.1–2.0). Multivariate analysis showed that Helicobacter pylori seroprevalence was high in children aged 6–10 and 11–15 years (OR: 1.5, 95% CI: 1.2–1.9 and OR: 1.9, 95% CI: 1.56–2.47 respectively), in lower‐middle SES (OR: 1.6, 95% CI: 1.2–2.1 and OR: 1.5, 95% CI: 1.10–2.0 respectively) and in uneducated fathers (OR: 1.58, 95% CI: 1.27–1.95). Conclusion: Helicobacter pylori seropositivity increases with age, in low‐middle SES and is related to father’s educational status. Reducing H. pylori seroprevalence will require improvement in sanitary conditions and educational status of the population.