Transfusion-associated graft-versus-host disease: Difference between revisions
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==Background== | ==Background== | ||
*> 24 hr, delayed complication of transfusion | *> 24 hr, delayed complication of transfusion | ||
*Mortality > 90%, usually within 1-3 | *Mortality > 90%, usually within 1-3 weeks of onset | ||
*Donor lymphocytes mount response against recipient tissue | *Donor lymphocytes mount response against recipient tissue | ||
*Risk factors: | *Risk factors (see also [[Blood products]]): | ||
**Cellular components (whole blood, pRBCs) | **Cellular components (whole blood, [[pRBCs]]) | ||
***Less incidence in platelet products | ***Less incidence in [[platelets|platelet products]] | ||
***Almost | ***Almost none in [[FFP]] | ||
**Recipient immunodeficiency | **Recipient immunodeficiency | ||
**Non-leukocyte irradiated blood products | **Non-leukocyte irradiated blood products | ||
| Line 13: | Line 13: | ||
**Blood products stored less than 11 days | **Blood products stored less than 11 days | ||
***Longer shelf time associated with less incidence | ***Longer shelf time associated with less incidence | ||
***In review of ~350 cases, only 10 identified between 11-14 days<ref>Kopolovic I et al. A systematic review of transfusion-associated graft-versus-host disease. Blood. 2015 Jul 16;126(3):406-14.</ref> | ***In review of ~350 cases, only 10 identified between 11-14 days<ref name="a">Kopolovic I et al. A systematic review of transfusion-associated graft-versus-host disease. Blood. 2015 Jul 16;126(3):406-14.</ref> | ||
==Clinical Features== | ==Clinical Features== | ||
*Signs and symptoms include<ref> | *Signs and symptoms include<ref name="a"></ref>: | ||
**Rash ~80% | **[[Rash]] ~70-80% | ||
** | **[[Diarrhea]] ~40% | ||
**[[Hepatomegaly]] ~15% | |||
**Hepatomegaly ~15% | **[[liver failure|Liver injury]] ~70% | ||
**Liver injury ~70% | **[[Pancytopenia]] ~65% | ||
**Pancytopenia ~65% | *Transfusion usually within 1-2 weeks prior to symptom onset | ||
*Transfusion usually within 1-2 | *By definition, can be between 2 days - 6 weeks from transfusion | ||
*By definition, can be between 2 days - 6 | |||
==Differential== | ==Differential== | ||
{{Transfusion reaction types}} | {{Transfusion reaction types}} | ||
==Evaluation== | |||
===Diagnosis=== | |||
*Skin biopsy will suggest this pathology | |||
*Definitive diagnosis if patient's lymphocytes are found to have a different HLA phenotype from host tissue cells | |||
==Management== | ==Management== | ||
| Line 34: | Line 38: | ||
**Use leukocyte reduced, irradiated blood products | **Use leukocyte reduced, irradiated blood products | ||
*Supportive | *Supportive | ||
*Immunosuppressants, corticosteroids, cytotoxic agents have questionable efficacy | *Immunosuppressants, [[corticosteroids]], cytotoxic agents have questionable efficacy | ||
*Stem cell transplantation rescue | *Stem cell transplantation rescue | ||
==See Also== | |||
*[[Acute transfusion reaction]] | |||
*[[GVHD]] | |||
==External Links== | |||
*[http://transfusionontario.org/en/cmdownloads/categories/bloody_easy/ Bloody Easy 3: Blood Transfusions, Blood Alternatives and Transfusion Reactions - A Guide to Transfusion Medicine] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Heme/Onc]] | [[Category:Heme/Onc]] | ||
Latest revision as of 18:57, 1 October 2019
Background
- > 24 hr, delayed complication of transfusion
- Mortality > 90%, usually within 1-3 weeks of onset
- Donor lymphocytes mount response against recipient tissue
- Risk factors (see also Blood products):
- Cellular components (whole blood, pRBCs)
- Less incidence in platelet products
- Almost none in FFP
- Recipient immunodeficiency
- Non-leukocyte irradiated blood products
- Donor HLA homozygosity with recipient heterozygosity
- Non-HLA matched blood products
- Blood products stored less than 11 days
- Longer shelf time associated with less incidence
- In review of ~350 cases, only 10 identified between 11-14 days[1]
- Cellular components (whole blood, pRBCs)
Clinical Features
- Signs and symptoms include[1]:
- Rash ~70-80%
- Diarrhea ~40%
- Hepatomegaly ~15%
- Liver injury ~70%
- Pancytopenia ~65%
- Transfusion usually within 1-2 weeks prior to symptom onset
- By definition, can be between 2 days - 6 weeks from transfusion
Differential
Transfusion Reaction Types
- Acute
- Delayed
Evaluation
Diagnosis
- Skin biopsy will suggest this pathology
- Definitive diagnosis if patient's lymphocytes are found to have a different HLA phenotype from host tissue cells
Management
- Preventative
- Identify vulnerable populations
- Use leukocyte reduced, irradiated blood products
- Supportive
- Immunosuppressants, corticosteroids, cytotoxic agents have questionable efficacy
- Stem cell transplantation rescue