Lebanon, NH – A new multi-institute study led by researchers at Dartmouth Health and Geisel School of Medicine at Dartmouth suggests that alpha-gal syndrome, the tick-borne disease that can result in a chronic allergy to meat and animal byproducts, also may complicate certain patients' ability to safely receive a blood plasma or platelet transfusion.
Alpha-gal syndrome (AGS) is a serious allergy transmitted by a sugar molecule called alpha-gal in the saliva of Lone Star ticks. First documented in 2025, the allergy is triggered by ingesting meat from mammals, such as beef, pork and lamb, as well as other products from these animals, like dairy and gelatin. An AGS reaction can trigger delayed, severe reactions like hives, stomach pain and anaphylaxis.
At the same time, Dartmouth Health’s Dartmouth Hitchcock Medical Center (DHMC) has seen an uptick in recent years of patients with type O blood experiencing severe and even life-threatening allergic reactions after receiving platelets or plasma from type B or AB donors.
DHMC pathologists Nancy M. Dunbar, MD , and Richard M. Kaufman, MD , who led the study published August 24 in JAMA Internal Medicine , hypothesized that these patients may have pre-existing antibodies to alpha-gal from tick bites, and that hospitals in regions with higher concentrations of AGS patients, like DHMC, might also see an increase of allergic reactions in O patients receiving B or AB units. The international team of researchers now reports that transfusion-related alpha-gal syndrome, or TRAGS, is a legitimate manifestation of AGS and should be taken into account in the safety practices of hospital transfusion services.
“We anticipate that this will change transfusion practices in the U.S., at least in AGS high-prevalence regions,” said Kaufman, the study's corresponding author and a professor of pathology and laboratory medicine at Geisel. “DHMC has already taken the step to cease giving transfusions of B or AB platelets to O patients to avoid potential injury to these patients.”
Dunbar and Kaufman’s study was carried out at 40 sites in five countries, where over 550,000 platelet and plasma transfusions were analyzed. The study also included Anne G. Hoen, PhD , an associate professor of epidemiology, biomedical data science, and microbiology and immunology at Geisel.
In the study's nine U.S. sites in areas with high concentrations of AGS, significantly more allergic transfusion reactions were reported among type O patients who received B or AB units compared to type O patients who received O units.
“The changing climate and ensuing greater proliferation of ticks is leading to illnesses and symptoms we had not seen before, and we continue to learn about them in real time,” said Dunbar, the study's senior author and a professor of medicine and pathology and laboratory medicine at Geisel. “AGS is a particularly fascinating and challenging tickborne disease as it causes this life-threatening allergy the patient did not have before, and now we know the risk is even greater for AGS patients who are type O. It is our hope that other hospitals, especially in regions with high tick populations, will follow DHMC’s lead and avoid B and AB units for O-group patients in need of platelet or plasma transfusion. Even if it’s an abundance of caution, it could save the patient’s life.”
Dartmouth Health, New Hampshire’s only academic health system and largest private employer, serves patients across New England. Dartmouth Health provides access to more than 2,300 providers in nearly every area of medicine, delivering care at its flagship hospital, Dartmouth Hitchcock Medical Center (DHMC) in Lebanon, NH. Its network of hospitals, outpatient centers, clinics and home care facilities, spans a broad geographical area. Year after year, DHMC is named the #1 hospital in New Hampshire by U.S. News & World Report , and is consistently recognized for high performance in numerous clinical specialties and procedures. Dartmouth Health includes Dartmouth Cancer Center, northern New England’s only National Cancer Institute-designated Comprehensive Cancer Center s and one of less than than 60 total nationally; Dartmouth Health Children’s, which includes the state’s only children’s hospital (Children’s Hospital at DHMC/CHaD) and more than 20 locations around the region; eight member hospitals in Lebanon, Keene, Claremont, Hampstead, and New London, NH, and Windsor and Bennington, VT; Dartmouth Health Home Care; Dartmouth Health Connected Care Center for Telehealth, serving patients as far away as Texas; and more than 30 primary and multi-specialty clinics across New Hampshire and Vermont. Through its partnership with Dartmouth College, Dartmouth’s Geisel School of Medicine and the White River Junction VA Medical Center, Dartmouth Health trains nearly 400 medical residents and fellows annually and performs cutting-edge research and clinical trials with international impact. Dartmouth Health and its more than 16,000 employees are committed to serving the healthcare needs of everyone in the communities it serves and to providing every patient with exceptional, state-of-the-art, personalized care. Learn more at dartmouth-health.org .
JAMA Internal Medicine
10.1001/jamainternmed.2026.3983
Randomized controlled/clinical trial
People
Epidemiologic Study of Transfusion-Related Alpha-Gal Syndrome
24-Aug-2026
Dr Metcalf reported receiving grants from Werfen, Haemonetics, Hemosonics, and Octapharma and personal fees from Werfen, Cerus, and UpToDate outside the submitted work and codeveloping a data visualization tool that has been disclosed as an invention but is not currently commercialized. Dr Cohn reported receiving personal fees from the Association for the Advancement of Blood and Biotherapies during the conduct of the study. Dr Crowe reported receiving personal fees from Terumo BCT and Plas Free, Ltd outside the submitted work. Dr Delaney reported receiving personal fees from Grifols outside the submitted work. Dr Ikeda reported receiving grants from Hokuyo Denki, Kyokuto Pharmaceutical Industrial Co, Ltd and personal fees from GSK, JB, Nippon Shinyaku, Novartis, PharmaEssentia, Recordati Rare Diseases, Takeda, Kyowa-Kirin, Kissei, and Zeria outside the submitted work. Dr Menzies Wojtowicz reported receiving honoraria from BeOne, Eli Lilly, and Johnson & Johnson; personal fees from AstraZeneca, AbbVie, and Eli Lilly; and research funding from AbbVie; and receiving personal fees from AstraZeneca, Eli Lilly, and Johnson & Johnson outside the submitted work. Dr Poisson reported receiving personal fees from Cerus outside the submitted work. Dr Sato reported receiving research funding from the Japanese Red Cross and grants from the Japan Society for the Promotion of Science outside the submitted work. Dr Thibodeaux reported receiving personal fees from the University of Nebraska and TerumoBCT outside the submitted work and serving on the Board of Directors for the Association for the Advancement of Blood and Biotherapies. Dr Zheng reported serving on the Takeda Advisory Board and Sanofi Advisory Board, receiving nonfinancial support from The Blood Project Board of Trustees and a grant to the University of Kansas Medical Center from Lee's Pharmaceuticals Research Collaboration and cofounding Clotsolution outside the submitted work. Dr Dunbar reported receiving personal fees from Grifols outside the submitted work. No other disclosures were reported.