DNA polymorphism analysis in transfusion-associated graft-versus-host disease.
During cardiac surgery for transposition of the great arteries at age 7 weeks, a female infant received blood, fresh frozen plasma and platelet transfusions. Eleven days postoperatively, she developed bloody diarrhoea, fever, an erythematous macular rash, hepatomegaly, seizures and pancytopaenia. A clinical diagnosis of transfusion related graft-versus-host disease (GVHD) was supported by skin histopathology. DNA polymorphism studies confirmed that circulating lymphocytes in peripheral blood and infiltrating cells in the skin were foreign in origin and were derived from transfused blood cells. No underlying immunodeficiency was identified. Treatment with steroids cyclosporin and antithymocyte globulin was unsuccessful and death occurred 2 months after surgery. The features of fever, rash, diarrhoea, liver dysfunction and pancytopaenia which characterize GVHD may mimic drug reactions or viral infection. In addition to histological features on skin biopsy. DNA polymorphism studies on skin and blood samples provide a unique and sensitive method to confirm GVHD. Irradiation of blood products should be considered for acutely compromised infants requiring urgent cardiac surgery.
Warren
L J
LJ
Department of Dermatology, Flinders Medical Centre, Bedford Park, Australia. lvwarren@olis.net.au
Simmer
K
K
Roxby
D
D
Grist
S
S
Seshadri
R
R
Morley
A
A
D004276:DNA, Satellite / Q000235:genetics*; D017809:Fatal Outcome; D005260:Female; D006086:Graft vs Host Disease / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics*; D006801:Humans; D016130:Immunophenotyping; D007223:Infant; D007431:Intraoperative Complications / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D018895:Microsatellite Repeats / Q000235:genetics; D011110:Polymorphism, Genetic / Q000235:genetics*; D065227:Transfusion Reaction; D014188:Transposition of Great Vessels / Q000601:surgery
D004276:DNA, Satellite