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