Transfusion-associated graft-versus-host disease
- Arthur J Silvergleid, MD
Arthur J Silvergleid, MD
- Section Editor — Transfusion Medicine
- Affiliate Associate Professor, Department of Pathology and Cell Biology
- University of South Florida, College of Medicine
- Medical Director, OneBlood, Inc.
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 "Hemolytic transfusion reactions".)
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 .
- Ferrara JL, Deeg HJ. Graft-versus-host disease. N Engl J Med 1991; 324:667.
- Hathaway WE, Githens JH, Blackburn WR, et al. Aplastic anemia, histiocytosis and erythrodermia in immunologically deficient children. Probable human runt disease. N Engl J Med 1965; 273:953.
- Brubaker DB. Human posttransfusion graft-versus-host disease. Vox Sang 1983; 45:401.
- Schroeder ML. Transfusion-associated graft-versus-host disease. Br J Haematol 2002; 117:275.
- Maung ZT, Wood AC, Jackson GH, et al. Transfusion-associated graft-versus-host disease in fludarabine-treated B-chronic lymphocytic leukaemia. Br J Haematol 1994; 88:649.
- Leitman SF, Tisdale JF, Bolan CD, et al. Transfusion-associated GVHD after fludarabine therapy in a patient with systemic lupus erythematosus. Transfusion 2003; 43:1667.
- Sakakibara T, Juji T. Post-transfusion graft-versus-host disease after open heart surgery. Lancet 1986; 2:1099.
- Shivdasani RA, Haluska FG, Dock NL, et al. Brief report: graft-versus-host disease associated with transfusion of blood from unrelated HLA-homozygous donors. N Engl J Med 1993; 328:766.
- Aoun E, Shamseddine A, Chehal A, et al. Transfusion-associated GVHD: 10 years' experience at the American University of Beirut-Medical Center. Transfusion 2003; 43:1672.
- FDA Memorandum: License amendments and procedures for gamma irradiation of blood products. June 22, 1993.
- von Fliedner V, Higby DJ, Kim U. Graft-versus-host reaction following blood product transfusion. Am J Med 1982; 72:951.
- Leitman SF, Holland PV. Irradiation of blood products. Indications and guidelines. Transfusion 1985; 25:293.
- De Dobbeleer GD, Ledoux-Corbusier MH, Achten GA. Graft versus host reaction. An ultrastructural study. Arch Dermatol 1975; 111:1597.
- http://www.cdc.gov/dengue/ (Accessed on August 15, 2014).
- Woods WG, Lubin BH. Fatal graft versus host disease following a blood transfusion in a child with neuroblastoma. Pediatrics 1981; 67:217.
- Rosen RC, Huestis DW, Corrigan JJ Jr. Acute leukemia and granulocyte transfusion: Fatal graft-versus-host reaction following transfusion of cells obtained from normal donors. J Pediatr 1978; 93:268.
- Betzhold J, Hong R. Fatal graft-versus-host disease after a small leukocyte transfusion in a patient with lymphoma and varicella. Pediatrics 1978; 62:63.
- Hutchinson K, Kopko PM, Muto KN, et al. Early diagnosis and successful treatment of a patient with transfusion-associated GVHD with autologous peripheral blood progenitor cell transplantation. Transfusion 2002; 42:1567.
- Neves JF, Marques A, Valente R, Barata D. Nonlethal, attenuated, transfusion-associated graft-versus-host disease in an immunocompromised child: case report and review of the literature. Transfusion 2010; 50:2484.
- Agbaht K, Altintas ND, Topeli A, et al. Transfusion-associated graft-versus-host disease in immunocompetent patients: case series and review of the literature. Transfusion 2007; 47:1405.
- Triulzi D, Duquesnoy R, Nichols L, et al. Fatal transfusion-associated graft-versus-host disease in an immunocompetent recipient of a volunteer unit of red cells. Transfusion 2006; 46:885.
- Klein HG. Transfusion-associated graft-versus-host disease: less fresh blood and more gray (Gy) for an aging population. Transfusion 2006; 46:878.
- Williamson LM, Stainsby D, Jones H, et al. The impact of universal leukodepletion of the blood supply on hemovigilance reports of posttransfusion purpura and transfusion-associated graft-versus-host disease. Transfusion 2007; 47:1455.
- Akahoshi M, Takanashi M, Masuda M, et al. A case of transfusion-associated graft-versus-host disease not prevented by white cell-reduction filters. Transfusion 1992; 32:169.
- Hayashi H, Nishiuchi T, Tamura H, Takeda K. Transfusion-associated graft-versus-host disease caused by leukocyte-filtered stored blood. Anesthesiology 1993; 79:1419.
- Fast LD, DiLeone G, Marschner S. Inactivation of human white blood cells in platelet products after pathogen reduction technology treatment in comparison to gamma irradiation. Transfusion 2011; 51:1397.
- Grass JA, Wafa T, Reames A, et al. Prevention of transfusion-associated graft-versus-host disease by photochemical treatment. Blood 1999; 93:3140.
- Linden JV, Pisciotto PT. Transfusion-associated graft-versus-host disease and blood irradiation. Transfus Med Rev 1992; 6:116.
- Fast LD. Developments in the prevention of transfusion-associated graft-versus-host disease. Br J Haematol 2012; 158:563.
- PATHOGENESIS AND INCIDENCE
- Immunodeficient states
- Partial HLA matching
- Implicated blood products
- CLINICAL PRESENTATION
- DIFFERENTIAL DIAGNOSIS
- TREATMENT AND PREVENTION
- - Irradiation procedure
- - Leukodepletion
- - Other methods for WBC inactivation
- SUMMARY AND RECOMMENDATIONS
- Implicated products
- Presentation and diagnosis