Diagnosis Of Transfusion-associated Graft-versus-host Disease Research Articles

Transfusion-Associated Graft-Versus-Host Disease in Adults.

Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare but fatal complication of blood transfusion that usually develops two to 30 days following a blood transfusion giving rise to graft versus host disease (GVHD) clinical features that are consisting of fever, skin rash, jaundice, diarrhea, and pancytopenia. The disease is fulminant in most patients with a mortality rate of >90% of cases. The main aim of this review is to enhance awareness among medical practitioners about this fatal disease. Data were extracted manually from the main medical databases (Medline, Scopus, and Google Scholar) after the revision of selected articles and assessed for their contribution to the knowledge of TA-GVHD. TA-GVHD occurs when the viable donor T-cells in the blood or blood products attack the recipient's tissues which his/her immune system is incapable to destroy due to several reasons. The recipient's tissues that are usually involved in TA-GVHD include the liver, intestine, skin, lungs, and bone marrow. Any blood component either whole blood, packed red blood cells (RBCs), platelets, or fresh non-frozen plasma that contains viable T lymphocytes can cause TA-GVHD. Host immunodeficiency, transfusion of fresh blood, and partial human leukocyte antigen (HLA) matching between the donors and the recipients represent the major risk factors of TA-GVHD. Partial HLA matching includes immunocompetent recipients who receive blood from a first-degree relative also, seen in genetically homogenous populations because of high rates of consanguineous marriage. The diagnosis of TA-GVHD is mainly suspected based on clinical manifestations. However, a histopathological study of either skin or rectal biopsy is diagnostic. The treatment of TA-GVHD is generally not effective, unless the patient received emergency stem cell transplantation, while prevention via irradiation of blood or blood products represents the standard of care for this disease. In conclusion, medical practitioners should have a high index of suspicion for this disease. Moreover, future clinical trials targeting and comparing the outcomes of the different therapeutic options for TA-GVHD are required.

Transfusion Associated Graft Versus Host Disease: A Case Report and Review of Literature

Transfusion associated graft versus host disease (TA-GvHD) is a rare but usually fatal complication of transfusion of cellular blood products. It is seen usually in immunosuppressed individuals due to engraftment of viable T lymphocytes but it may also occur in immunocompetent individuals. Patients present with fever, skin rash, diarrhoea, hepatic dysfunction and bone marrow aplasia which manifests as pancytopenia. The diagnosis of TA-GvHD is often delayed because of lack of awareness due to the non-specific manifestations and often these symptoms are attributed to the underlying illness. We present here a case report of fatal TA-GvHD in an immunocompetent patient, post coronary artery bypass grafting surgery after transfusion of blood products. The patient died 27 days after a blood transfusion. An increased risk of TA-GvHD following bypass grafting and other surgical procedures where cardiopulmonary bypass is required has been perceived. TA-GvHD is under reported and the incidence is felt to be too low to warrant routine irradiation of cellular products. Physicians, surgeons and transfusion centers should be aware of this rare but devastating complication of blood transfusion so as to either diagnose it early or rather prevent it.

Transfusion Associated Graft Versus Host Disease Following Whole Blood Transfusion from an Unrelated Donor in an Immunocompetent Patient

Graft-versus-host disease (GVHD) is a well-known complication of allogeneic bone marrow transplantation. Transfusion associated graft-versus-host disease (TA-GVHD) is much less common and nearly uniformly fatal complication of blood transfusion. The risk factors underlying the development of TA- GVHD are incompletely defined, but it is commonly seen in individuals with congenital or acquired immunodeficiency, transfusions from blood relatives, intrauterine transfusions and HLA-matched platelet transfusions. Diagnosis of TA-GVHD may be difficult at a time due to rarity in occurrence and overlapping clinical features with various infections and drug reactions. We describe a case of transfusion-associated GVHD that occurred after transfusion of whole blood from unrelated donor in an immunocompetent patient.

Transfusion‐associated graft‐versus‐host disease

Transfusion‐associated graft‐versus‐host disease

Rapid molecular cytogenetic diagnosis of transfusion associated graft-versus-host disease by fluorescent in situ hybridization (FISH)

Transfusion associated graft-versus-host disease (TA-GVHD) is a rare, dreadful complication of transfusion in immunocompromized and immunologically competent individuals. The diagnosis is often delayed, because of lack of awareness and the non-specific clinical features. We describe a rapid molecular cytogenetic analysis of FISH for the diagnosis of two cases of TA-GVHD with sex-mismatched donors. The use of FISH is a rapid and sensitive technique for the early diagnosis of TA-GVHD when the recipient and donor are of different gender.

Transfusion-associated graft-versus-host disease.

Transfusion-associated graft-versus-host disease.

Diagnostic features of transfusion associated graft versus host disease.

To define the immunopathological profile of transfusion associated graft versus host disease (TA-GvHD) to elucidate its pathophysiology and to determine if any features are of diagnostic value. Nine patients (age range 14-61 years) who developed histologically confirmed TA-GvHD between 1989 and 1992 were studied. Immunohistochemical analysis of frozen and formalin fixed skin biopsy tissue was performed. Sections were stained with antibodies to CD3, CD8, CD4 and HLA-DR, using a routine streptavidin-biotin technique with standard diaminobenzidine development. All biopsy specimens showed aberrant positive expression of HLA-DR by epidermal keratinocytes. In four patients, all of whom died, HLA-DR was diffusely expressed throughout the epidermis; in the other five cases keratinocyte expression of HLA-DR was more focal. In all biopsy specimens T cells had infiltrated the dermis and epidermis. In all nine cases CD4+ T helper/inducer cells were the predominant T cells. Immunohistochemical studies are of value in the diagnosis of TA-GvHD. Aberrant keratinocyte expression of HLA-DR and dermal and epidermal infiltration of CD4+ T cells are immunopathological features of TA-GvHD. Immunohistochemical analysis of skin biopsy tissue using antibodies to these markers is thus a useful investigation in pancytopenic patients presenting with unexplained rashes.

Transfusion‐associated graft‐versus‐host disease in a presumably immunocompetent patient after transfusion of stored packed red cells

A 54-year-old woman developed transfusion-associated graft-versus-host disease (TA-GVHD) after the transfusion of stored packed red cells obtained from unrelated donors. The patient was presumed to be immunocompetent. A diagnosis of TA-GVHD was made by clinical features and postmortem pathologic findings. Sex chromatin analysis of the patient's lymphocytes demonstrated chimerism. HLA typing of the blood donors revealed one to be HLA-homozygous for one of the patient's HLA haplotypes (A33-B44-Cblank). This case illustrates the risk in the general patient population of TA-GVHD after routine blood transfusion therapy. Workers should be aware of this possibility and should continue searching for an efficient way to prevent it.