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Immunoglobulin (Ig) A deficiency is characterized by undetectable levels of serum IgA and normal levels of other immunoglobulins (IgG, IgM) in patients more than 4 years of age. Although generally asymptomatic, pa- tients are at risk for anaphylactic reactions when receiv- ing allogeneic blood products from non-IgA deficient donors. We present a 35-year-old male with IgA deficiency who required anesthetic care during posterior spinal fusion. The basic principles of IgA deficiency are reviewed, general techniques to avoid allogeneic blood products presented, and specific care of the IgA deficient patient discussed including techniques to allow the use of alloge- neic blood products if needed.