Difference between revisions of "Transfusion-associated graft-versus-host disease"
ClaireLewis (talk | contribs) (→See Also) |
ClaireLewis (talk | contribs) (→See Also) |
||
| Line 43: | Line 43: | ||
==See Also== | ==See Also== | ||
*[[Acute transfusion reaction]] | *[[Acute transfusion reaction]] | ||
| − | *[[ | + | *[[GVHD]] |
==External Links== | ==External Links== | ||
Latest revision as of 18:57, 1 October 2019
Contents
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