Graft-versus-host disease (GVHD) is a rare complication that develops 4 to 30 days after a blood transfusion. Recognition is often delayed because nonspecific symptoms are attributed to the patient’s underlying diagnosis. Unlike GVHD associated with hematopoietic cell transplantation (HCT), ta-GVHD affects the transfusion recipient’s bone marrow. Thus, unlike HCT-associated GVHD, ta-GVHD is almost always fatal.
This topic review will discuss the pathogenesis, presentation, diagnosis and management of ta-GVHD.
Other delayed complications of blood transfusion are presented in separate topic reviews. (See "Transfusion-associated immune and non immune-mediated hemolysis".)
GVHD associated with HCT is also discussed in detail separately. (See "Clinical manifestations, diagnosis, and grading of acute graft-versus-host disease" and "Clinical manifestations, diagnosis, and grading of chronic graft-versus-host disease".)
PATHOGENESIS AND INCIDENCE
GVHD results from an attack by viable immunocompetent donor lymphocytes on the recipient's antigen presenting tissues. This immunologic assault is manifested clinically by dysfunction of the skin, liver, gastrointestinal tract and bone marrow. The effect on the bone marrow distinguishes transfusion-associated GVHD (ta-GVHD) from transplantation-associated disease. With HCT, the bone marrow cells in the recipient are of donor origin and are therefore exempted from attack. Thus, bone marrow aplasia, which is the primary cause of death in ta-GVHD, is an infrequent complication after HCT .