View source for Transfusion-associated graft-versus-host disease

== Background ==

* Caused by transfusion of immune cells that mount an immune response against the recipient's tissue
* Usually in immunocompromised patients or patients who receive haploidentical blood products
* Rare
* Mortality over 90%, most mediated by severe sepsis

== Clinical Manifestations ==

* Usually starts 1 to 2 weeks after transfusion
* Fever, rash, liver dysfunction, and diarrhea, followed by pancytopenia

== Management ==

* Supportive care (including antibiotics)

== Prevention ==

* Use irradiated blood components for recipients at high risk
* High risk patients include:
** Patients with severe congenital T-cell immunodeficiency
** Intrauterine transfusions (IUT)
** Neonatal exchange transfusions for infants with prior IUT
** Neonatal top-up transfusions for infants with prior IUT
** Patients with [[Hodgkin lymphoma]]
** Patients undergoing stem cell transplant
** Recipients of direct transfusions from family members
** Recipients of HLA-matched platelets
** Patients treated with [[purine analogues]] (e.g. [[fludarabine]]), [[purine antagonists]] (e.g. [[bendamustine]]), [[alemtuzumab]], or [[anti-thymocyte globulin]]