Fatal graft-versus-host disease associated with transfusions of HLA-matched, HLA-homozygous platelets from unrelated donors.
BACKGROUND
Transfusion-associated graft-versus-host disease (TA-GVHD) due to blood from HLA-homozygous related and unrelated blood donors has been described.


METHODS
Fatal TA-GVHD due to the transfusion of HLA-matched platelets from an unrelated HLA-homozygous donor is reported. A 61-year-old man with a history of diabetes mellitus and myelodysplastic syndrome was diagnosed with acute myelogenous leukemia in November 1991. Induction chemotherapy resulted in aplasia, which was followed by a normocellular marrow with mild dysplasia and continued karyotypic abnormalities. High-dose chemotherapy was given in a second attempt to achieve complete remission. HLA-matched platelets were ordered when platelet refractoriness developed. The patient was HLA-heterozygous for HLA-A and -B antigens (A2, 29; B37, 44). Over the next 7 days, four unirradiated HLA-matched plateletpheresis units were transfused; one was probably homozygous for both HLA-A and -B antigens (A2, -; B44, -) and was transfused first, and three were probably homozygous for an HLA-B antigen (A2, 29; B44, -) and were white cell reduced. No blood relatives served as donors. Seven days after the first HLA-matched platelet transfusion, fever, chills, and diarrhea developed; 2 days later, a rash was present. Liver enzymes increased markedly. Renal and respiratory failure ensured. A skin biopsy was consistent with GVHD. Despite immunosuppressive therapy, the patient died 19 days after the first HLA-matched platelet transfusion.


CONCLUSIONS
TA-GVHD has been recognized in immunocompromised, HLA-heterozygous patients receiving blood from blood relatives who are HLA-homozygous. patients receiving blood from either blood relatives or non-blood relatives who are HLA-homozygous. This HLA-heterozygous patient received transfusions of unirradiated, class I HLA-homozygous platelets, which were specifically ordered as HLA-matched, and his death was attributed to TA-GVHD. Consideration should always be given to providing irradiated blood for immunosuppressed patients, especially when HLA-matched platelets are used, to prevent TA-GVHD.
Benson
K
K
Department of Pathology and Laboratory Medicine, University of South Florida College of Medicine, Tampa.
Marks
A R
AR
Marshall
M J
MJ
Goldstein
J D
JD
D001782:Blood Donors; D001792:Blood Platelets / Q000276:immunology*; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000209:etiology; D006680:HLA Antigens / Q000097:blood* / Q000235:genetics; D006650:Histocompatibility Testing; D006720:Homozygote; D006801:Humans; D008297:Male; D008875:Middle Aged; D065227:Transfusion Reaction
D006680:HLA Antigens