Transfusion-associated graft-versus-host disease

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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]

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

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

  1. 1.0 1.1 Kopolovic I et al. A systematic review of transfusion-associated graft-versus-host disease. Blood. 2015 Jul 16;126(3):406-14.