Transfusion‐associated graft‐versus‐host disease in immunocompetent patients: report of a fatal case associated with transfusion of blood from a second‐degree relative, and a survey of predisposing factors

Abstract

A patient without evident immune deficiency who received a transfusion of blood from a second-degree family member developed fatal transfusion-associated graft-versus-host disease (TA-GVHD). The donor was homozygous for an HLA haplotype for which the recipient was heterozygous (one-way HLA match). All 39 reported cases of TA-GVHD in immunocompetent patients were reviewed to ascertain the predisposing factors and to define the indications for irradiating blood for this population. HLA typing was described in 15 cases; in 13, including seven related and six unrelated donors, a one-way HLA match was present. Thirty-one (79%) of the 39 cases were reported from Japan (and 196 other cases are cited in the Japanese literature), but a one-way HLA match among unrelated donors at HLA-A, -B, -DR loci is only approximately two to four times more likely in Japanese persons than in whites. Fresh blood (< 96 hours old) was used in 29 (94%) of the 31 cases reported from Japan and in 33 (87%) of 38 cases overall (in one case, the age of the blood used was not reported). Thus, factors that appear to predispose to TA-GVHD in immunocompetent patients are a one-way HLA match, fresh blood, and, possibly, Japanese ancestry. Irradiating cellular blood components from all blood relatives of transfusion recipients will not completely eliminate the risk of TA-GVHD.

Nonlethal transfusion associated graft-versus-host disease in a severe combined immunodeficient patient

“…3 Fatal TAGVHD was observed in immunocompetent patients, transfused with blood from donors homozygous for a shared haplotype with the recipient. 2,4 Here we describe a favorable course of TAGVHD in a boy with X-linked SCID. 5 Despite intensive conditioning and haplo-identical bone marrow transplantation, erythrocyte transfusion-derived lymphocytes showed prolonged survival and were able to cause two subsequent episodes of TAGVHD.…”

A review of transfusion practice before, during, and after hematopoietic progenitor cell transplantation

“…20 The lymphocytes may engraft in a susceptible immunosuppressed host and cause transfusion-associated graft-versus-host disease (TA-GVHD). 21 As a consequence of immunosuppressive treatment, both autologous and allogeneic HPC transplantation recipients are at increased risk for the development of TA-GVHD. 22,23 Limited data suggest that patients with cancer, bone marrow-failure states, and other diagnoses, such as inborn errors of metabolism and hemoglobinopathies, who may be treated by HPC transplantation, are also at increased risk.…”

“…22,23 Limited data suggest that patients with cancer, bone marrow-failure states, and other diagnoses, such as inborn errors of metabolism and hemoglobinopathies, who may be treated by HPC transplantation, are also at increased risk. 21,22,24 Although TA-GVHD is uncommon, the mortality rate is 88%. Clinical symptoms of TA-GVHD occur between 4 and 30 days after transfusion and may include fever, maculopapular rash, bloody diarrhea, and/or pancytopenia.…”

Perfusionist strategies for blood conservation in pediatric cardiac surgery

“…Its immunological origin via an antibody-mediated reaction is strongly suspected. Graft vs host disease is a very rare but usually fatal complication that also demonstrates the conjunction of immunity and blood transfusion [11,12] . All these negative side effects of homologous blood transfusion are currently more obvious because of the dramatic decrease in postoperative mortality and morbidity.…”