GVHD after transfusion of stored RBC concentrates in a solution of mannitol, adenine, phosphate, citrate, glucose, and NaCl following trauma.
BACKGROUND
It has not previously been reported that WBC-reduced RBC preparations can cause transfusion-associated GVHD, even in an immunocompetent individual.


METHODS
A 74-year-old man suffered a hemorrhage from the mesentery of the transverse colon after a traffic accident. During surgery, he received 10 units of RBCs from 10 donors in a solution containing mannitol, adenine, phosphate, citrate, glucose and NaCl (MAP). MAP RBCs had been stored for 7 to 8 days before use. On the 27th day after surgery, an erythematous, pruritic rash appeared over the face, neck, and trunk, which was associated with low-grade fever and pancytopenia. Transfusion-associated GVHD was strongly suspected and was confirmed by skin biopsy. To determine the origin of lymphocytes causing GVHD, several microsatellite loci were amplified from DNA of the patient's nails and blood and from blood samples of all 10 RBC donors by using PCR. Amplified alleles derived from the patient's blood were identical to those from one of the 10 samples.


CONCLUSIONS
These findings indicate that transfusions of MAP-RBCs can cause transfusion-associated GVHD in an elderly but immunocompetent host.
Kita
T
T
Departments of Internal Medicine and Surgery, Jyouhana Kousei Hospital, Toyama, Japan. kitatoshi@ipch.kamazawa.ishikawa.jp
Nei
J
J
Matsu
T
T
Yoshiba
H
H
Matsuda
T
T
Yahagi
H
H
Uchida
S
S
Nakao
S
S
D000063:Accidents, Traffic; D000225:Adenine; D000368:Aged; D001793:Blood Preservation; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000209:etiology*; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008353:Mannitol; D018895:Microsatellite Repeats / Q000235:genetics; D011110:Polymorphism, Genetic; D012965:Sodium Chloride; D014947:Wounds and Injuries / Q000628:therapy*
C075774:MAP solution; D008353:Mannitol; D012965:Sodium Chloride; D000225:Adenine