Transfusion-associated graft-versus-host disease: Difference between revisions
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==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== | ||
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*Immunosuppressants, corticosteroids, cytotoxic agents have questionable efficacy | *Immunosuppressants, corticosteroids, cytotoxic agents have questionable efficacy | ||
*Stem cell transplantation rescue | *Stem cell transplantation rescue | ||
==See Also== | |||
==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== | ||
Revision as of 21:18, 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
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
See Also
External Links
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/