Transfusion-Associated Graft v. Host Disease

Updated June 1, 2014
Author: T. Hayes

Description: Synopsis of TA-GvHD as a delayed complication of Blood Producxt Transfusion

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Introduction:

Transfusion-associated graft versus host disease (ta-GVHD) does not occur after most transfusions because the donor lymphocytes are destroyed by the recipient's immune system before they can mount a response against the host. However, this protective response does not occur in two settings:

 

Implicated products — Ta-GVHD has been reported after the administration of

 

In comparison, ta-GVHD does not appear to be induced by

Presentation and diagnosis —  Ta-GVHD develops 4 to 30 days after blood transfusion. Patients typically present with fever and rash. Other symptoms include anorexia, vomiting, abdominal pain, profuse diarrhea, and cough.
The main laboratory findings are pancytopenia due to a strikingly hypocellular marrow, abnormal liver function tests, and electrolyte abnormalities induced by diarrhea.
The diagnosis is suggested from biopsy of affected skin, which classically reveals vacuolization of the basal layer and a histiocytic infiltrate, which is also seen in the aplastic bone marrow. The definitive diagnosis is established if the circulating lymphocytes are shown to have a different HLA phenotype from host tissue cells (ie, from the donor).
Management — Ta-GVHD is almost universally fatal; there is no effective treatment.
Prevention can be best achieved by inactivating transfused lymphocytes by exposing all lymphocyte-containing components to gamma irradiation. This procedure should be followed for patients who are immunosuppressed, who have received a hematopoietic cell transplant (HCT), who are getting blood components from a family donor, or who are given HLA-matched platelets.
Certain pathogen reduction technologies, capable of reducing the active pathogen load as well as abrogating selected white cell immune functions and preventing T cell proliferation, are in current use in some countries, and serve as alternatives to gamma irradiation. (See 'Other methods for WBC inactivation' above.)
Leukodepletion should not be used as an alternative to gamma irradiation for those patients at increased risk of ta-GVHD


Comparison of Transfusion Associated GvHD to Bone Marrow GvHD

Symptoms

BMT-GvHD

TA-GvHD

Onset 35-70 days 2-30 days
Skin Rash Present Present
Symptoms Severe Mild
Liver enzymes elevated elevated
Pancytopenia rare frequent
Marrow Hypoplasia negative positive
Occurence 70% about 1%
Response to Therapy 80-90% None
Mortality 10-15% 90-100%

Patients at Risk for TA-GvHD


Prevention of TA-GvHD: Blood Component Irradiation before Transfusion

Component Irradiation:

If you have a Patient At Risk, let the Blood Bank know you need:

Irradiated Blood Components


References

UpToDate (through MMC or Mercy Medical Library or by subscription) has a nice synopsis and list of references.