Transfusion-associated graft-versus-host disease

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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]

Clinical Features

  • 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

Management

  • Preventative
    • Identify vulnerable populations
    • Use leukocyte reduced, irradiated blood products
  • Supportive
  • Immunosuppressants, corticosteroids, cytotoxic agents have questionable efficacy
  • Stem cell transplantation rescue

Sources

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