Fatal transfusion-associated graft-versus-host disease in an immunocompetent recipient of a volunteer unit of red cells

ArticleinTransfusion 46(6):885-8 · July 2006with13 Reads
DOI: 10.1111/j.1537-2995.2006.00819.x · Source: PubMed
Abstract
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.
    • "According to the literature, cases of TA-GVHD have been reported in severely immunocompromised patients, including patients with congenital immunodeficiencies, in bone marrow transplant recipients, as well as in cancer patients treated with chemotherapy or radiotherapy [2,56789101112131415. This serious transfusion associated adverse reaction has also been reported in presumed immunocompetent patients who received blood from homozygous donors with shared HLA haplotypes or from a family member1617181920212223242526272829303132333435. Although the minimum concentration of lymphocytes in the donor blood that can initiate TA-GVHD is unknown, a number of lymphocytes as low as 1610 4 /kg of the recipient weight may be sufficient to cause TA-GVHD [36] . "
    [Show abstract] [Hide abstract] ABSTRACT: Irradiation of whole blood and blood components before transfusion is currently the only accepted method to prevent Transfusion-Associated Graft-Versus-Host-Disease (TA-GVHD). However, choosing the appropriate technique to determine the dosimetric parameters associated with blood irradiation remains an issue. We propose a dosimetric system based on the standard Fricke Xylenol Gel (FXG) dosimeter and an appropriate phantom. The modified dosimeter was previously calibrated using a (60)Co teletherapy unit and its validation was accomplished with a (137)Cs blood irradiator. An ionization chamber, standard FXG, radiochromic film and thermoluminescent dosimeters (TLDs) were used as reference dosimeters to determine the dose response and dose rate of the (60)Co unit. The dose distributions in a blood irradiator were determined with the modified FXG, the radiochromic film, and measurements by TLD dosimeters. A linear response for absorbed doses up to 54 Gy was obtained with our system. Additionally, the dose rate uncertainties carried out with gel dosimetry were lower than 5% and differences lower than 4% were noted when the absorbed dose responses were compared with ionization chamber, film and TLDs.
    Full-text · Article · Jun 2013
    • "ve diğer kardiyovasküler cerrahilerde kardiyopulmoner baypas gereksiniminin hastalar immün açıdan yeterli dahi olsa TA-GVHH gelişimi açısından risk oluşturduğu bildi- rilmiştir. [10,11] Bunun nedeni tam olarak bilinmese de daha genç lenfositlerin bulunduğu göreceli taze kanın kullanılmasının hastalık gelişimi ihtimalini artırdığı öne sürülmektedir. [11] Transfüzyon ilişkili graft versus host hastalığı için standart bir tedavi yöntemi yoktur. Japonya'da yapılan deneysel çalışmalarda klorokin ve nafomostat mesilate adlı ilaçların kombine kullanılması ile etkili olabileceği yönünde ipuçları bulunmaktadır. [1,3] Olgumuzda antibiyotik tedavisi, taze dondurulmuş plazma , sıvı elektrolit teda"
    Article · Oct 2012
    • "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. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Nov 2010
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