title: Diagnostic features of transfusion associated graft versus host disease.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pathology, University of Newcastle Upon Tyne, Royal Victoria Infirmary.
authors.forename: A L
authors.initials: AL
authors.lastname: Appleton
authors.forename: L
authors.initials: L
authors.lastname: Sviland
authors.forename: A D
authors.initials: AD
authors.lastname: Pearson
authors.forename: J
authors.initials: J
authors.lastname: Wilkes
authors.forename: M A
authors.initials: MA
authors.lastname: Green
authors.forename: A J
authors.initials: AJ
authors.lastname: Malcolm
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D006684:HLA-DR Antigens / Q000276:immunology; D006801:Humans; D007150:Immunohistochemistry; D015603:Keratinocytes / Q000276:immunology; D008297:Male; D008875:Middle Aged; D013601:T-Lymphocytes / Q000276:immunology; D006377:T-Lymphocytes, Helper-Inducer / Q000276:immunology; D065227:Transfusion Reaction
chemical_list: D006684:HLA-DR Antigens