Transfusion-associated graft-versus-host disease
From IDWiki
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