Transfusion-Associated Graft-Versus-Host Disease with a Non-fatal Course

Transfusion associated graft versus host disease

“…Overall mortality is reported to be more than 90%. [ 2 3 ] In the present case, drug reaction is a possibility, but the course of events, pancytopenia, temporal relationship with blood transfusion strongly suggest TA-GVHD. The findings of skin biopsy, though suggestive, but not pathognomonic of TA-GVHD and doesn’t differentiate it from drug reaction.…”

“…The pathophysiology of TA-GVHD is similar to GVHD associated with bone marrow transplantation (BMT) but, the clinical course in TA-GVHD is more fulminant with marrow aplasia and consequent complication of infections. [ 2 3 ] Marrow involvement does not occur in GVHD associated with BMT, as antigenically, marrow is similar to the graft. In TA-GVHD, the marrow is antigenically similar to the host tissue, against which the graft T cells react.…”

“…The findings of skin biopsy, though suggestive, but not pathognomonic of TA-GVHD and doesn’t differentiate it from drug reaction. [ 2 3 ]…”

Another Lethal Complication of Neonatal Blood Transfusion: Clinical Diagnosis?

“…A constellation of clinical features related to skin, gastrointestinal tract, liver and the bone marrow, in an appropriate setting, must arouse suspicion of TA-GVHD. A lower threshold for performing skin biopsy aids in supporting the diagnosis [10]; but the diagnosis is missed more easily in neonates than in adults. Skin rashes are very common for other reasons, especially in premature infants, occurring in 9-12% of them.…”

Red cell transfusion and the immune system

“…Pancytopenia follows, and mortality is high (> 90%), due to overwhelming sepsis. Management options are few and successful treatment is rare [138]. The emphasis is therefore on prevention by avoidance or irradiation of cellular products in at-risk patients (Table 3) [134].…”