Transfusion-associated graft-vs-host disease. A fatal case caused by blood from an unrelated HLA homozygous donor.
Transfusion-associated graft-vs-host disease (TA-GVHD) is a rare complication of transfusion. We report fatal TA-GVHD in a 63-year-old coronary artery bypass patient of European descent after an RBC transfusion from an unrelated donor. The patient had mild lymphocytopenia and received 2 80-mg doses of methylprednisolone and 7 units of RBCs. On day 14 after the transfusion, he had fever, elevated liver enzyme levels, and a macular rash. Pancytopenia and bone marrow aplasia developed. On day 26, he had a massive gastrointestinal hemorrhage and died. At autopsy, histopathologic findings of the skin, liver, bone marrow, and gastrointestinal tract were consistent with TA-GVHD. One donor of the transfused RBCs (3 days old at transfusion) had a 1-way HLA match with the patient. A method using multiplex polymerase chain reaction is presented. This patient with TA-GVHD and mild immune suppression suggests that blood component irradiation guidelines may need to be reevaluated.
Gorman
T E
TE
Department of Pathology, Ohio State University, Columbus 43210-1228, USA.
Julius
C J
CJ
Barth
R F
RF
Ng
A
A
Kennedy
M S
MS
Prior
T W
TW
Allen
J
J
Lasky
L C
LC
D001853:Bone Marrow / Q000473:pathology; D016172:DNA Fingerprinting; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000276:immunology* / Q000473:pathology; D006650:Histocompatibility Testing; D006720:Homozygote; D006801:Humans; D007165:Immunosuppression Therapy; D008214:Lymphocytes / Q000473:pathology; D008285:Major Histocompatibility Complex; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D010198:Pancytopenia / Q000209:etiology; D016133:Polymerase Chain Reaction; D012867:Skin / Q000473:pathology
D008775:Methylprednisolone