Transfusion-Associated Graft vs Host Disease

Epidemiology

  • Typically occurs 2-6 weeks after transfusion of PRBC
  • Rare
  • High risk groups: neonates/ post-cardiac surgery/ leukemia/ transplant recipients/ other severely immunocompromised patients (has not been reported in AIDS)

Physiology

  • Immunocompetent lymphocyte transfusion into immunocompromised recipient -> proliferation of donor lymphocytes -> response to host’s HLA antigens

Diagnosis

  • CHEM: elevated LFT’s
  • Skin Bx: diagnostic of GVHD

Clinical

  • Fever:
  • Rash:

Treatment

  • Irradiation of blood products (whole blood/ PRBC/ platelets) before use
    • Especially for ICU patients receiving family-donated blood products
  • Immunosuppression: ATG/ CSA/ steroids/ cytotoxics