Transfusion-associated graft-versus-host disease: Difference between revisions
(Text replacement - "*Diarrhea" to "*Diarrhea") |
(Text replacement - " wks " to " weeks ") |
||
| Line 1: | Line 1: | ||
==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 (see also [[Blood products]]): | *Risk factors (see also [[Blood products]]): | ||
| Line 23: | Line 23: | ||
**Liver injury ~70% | **Liver injury ~70% | ||
**Pancytopenia ~65% | **Pancytopenia ~65% | ||
*Transfusion usually within 1-2 | *Transfusion usually within 1-2 weeks prior to symptom onset | ||
*By definition, can be between 2 days - 6 | *By definition, can be between 2 days - 6 weeks from transfusion | ||
==Differential== | ==Differential== | ||
Revision as of 13:57, 30 March 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 ~80%
- Rash ~70%
- 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