Fatal transfusion-associated graft-versus-host disease in an immunocompetent recipient of a volunteer unit of red cells
Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA. Transfusion
(Impact Factor: 3.23).
07/2006; 46(6):885-8. DOI: 10.1111/j.1537-2995.2006.00819.x
Transfusion-associated graft-versus-host disease (TAGVHD) is a lethal complication of transfusion of nonirradiated cellular blood components to a susceptible recipient.
An 82-year-old man underwent cardiac surgery during which he received 6 units of red cells (RBCs) and a 6-unit pool of platelets (PLTs). He was discharged with a normal white blood cell (WBC) count and hemoglobin (Hb) level and a PLT count of 104x10(9) per L. He was readmitted 2 weeks later with a diffuse erythematous rash, a sore throat, and difficulty swallowing. His WBC count was 2.1x10(9) per L, his Hb level was 12.0 g per dL, and his PLT count was 131x10(9) per L. The next day he had worsening cytopenias: WBC count, 1x10(9) per L; Hb level, 10.9 g per dL; PLT count, 104x10(9) per L. He also had diarrhea. A marrow biopsy showed a severe hypoplasia without evidence of malignancy. A skin biopsy showed Grade II GVHD. The patient worsened and despite aggressive therapy he expired on Postoperative Day 42. DNA-based HLA testing of the 12 blood donors was performed. One of the RBC donors was found to be homozygous for an HLA Class I and Class II haplotype in the patient.
This is the first reported case in the United States of fatal TAGVHD from RBCs in an immunocompetent patient who received a randomly selected unit of RBCs from a donor who was homozygous for a shared HLA haplotype. The policy of selective irradiation should be reexamined.
Figures in this publication
Available from: Anne N Parker
- "This would be expected to increase the risk of TA-GvHD, especially if the platelet donor is homozygous for one of the recipient HLA-haplotypes (analogous to donations within families or within racial groups of limited genetic diversity). A case of TA-GvHD in an immunocompetent recipient following transfusion of blood components from an unrelated HLA homozygous donor was recently reported (Triulzi et al, 2006 "
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ABSTRACT: Several cases of TA-GvHD have been reported from Japan, where limited diversity of HLA haplotypes in the population increases the chance of a transfusion recipient receiving blood from a HLA haploidentical or HLA-identical donor (Ohto & Anderson, 1996). These observations are of relevance for patients receiving HLA-selected platelet concentrates from non-family members because of alloimmune refractoriness to random donor platelets. This would be expected to increase the risk of TA-GvHD, especially if the platelet donor is homozygous for one of the recipient HLA-haplotypes (analogous to donations within families or within racial groups of limited genetic diversity). A case of TA-GvHD in an immunocompetent recipient following transfusion of blood components from an unrelated HLA homozygous donor was recently reported (Triulzi et al, 2006), and four more cases were reported from Turkey in immunocompetent recipients who had received non-irradiated blood from relatives (Agbaht et al, 2007). The risk from HLA-selected platelets where the donor is not homozygous is uncertain. However, many transfusion centres now specifically maintain panels of homozygous donors for refractory patients, and in practice it is probably more reliable to recommend irradiation of all HLA-selected platelets, rather than risk the misallocation of some donations.
British Journal of Haematology 11/2010; 152(1):35-51. DOI:10.1111/j.1365-2141.2010.08444.x · 4.71 Impact Factor
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