Transfusion-associated graft-versus-host disease: Difference between revisions
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**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 ~80% | ||
**Rash ~70% | **Rash ~70% | ||
Revision as of 21:09, 25 July 2016
Background
- > 24 hr, delayed complication of transfusion
- Mortality > 90%, usually within 1-3 wks of onset
- Donor lymphocytes mount response against recipient tissue
- Risk factors:
- Cellular components (whole blood, pRBCs)
- Less incidence in platelet products
- Almost non 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 ~80%
- Rash ~70%
- Diarrhea ~40%
- Hepatomegaly ~15%
- Liver injury ~70%
- Pancytopenia ~65%
- Transfusion usually within 1-2 wks prior to symptom onset
- By definition, can be between 2 days - 6 wks from transfusion
Differential
Transfusion Reaction Types
- Acute
- Delayed
Management
- Preventative
- Identify vulnerable populations
- Use leukocyte reduced, irradiated blood products
- Supportive
- Immunosuppressants, corticosteroids, cytotoxic agents have questionable efficacy
- Stem cell transplantation rescue
References
- Roback JD (ed). Non-infectious complications of blood transfusion. Chapter 27, AABB Technical Manual, 17th edition. AABB, Bethesda, 2011.
- Callum JL et al. Chapter 5, Transfusion Reactions. Bloody Easy 3: Blood Transfusions, Blood Alternatives and Transfusion Reactions: A Guide to Transfusion Medicine, 3rd edition. Canada: Ontario Regional Blood Coordinating Network, 2011. Available from: http://transfusionontario.org/en/cmdownloads/categories/bloody_easy/