title: Transfusion-associated graft-vs-host disease. A fatal case caused by blood from an unrelated HLA homozygous donor.
abstract: 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.
authors.affiliation: Department of Pathology, Ohio State University, Columbus 43210-1228, USA.
authors.forename: T E
authors.initials: TE
authors.lastname: Gorman
authors.forename: C J
authors.initials: CJ
authors.lastname: Julius
authors.forename: R F
authors.initials: RF
authors.lastname: Barth
authors.forename: A
authors.initials: A
authors.lastname: Ng
authors.forename: M S
authors.initials: MS
authors.lastname: Kennedy
authors.forename: T W
authors.initials: TW
authors.lastname: Prior
authors.forename: J
authors.initials: J
authors.lastname: Allen
authors.forename: L C
authors.initials: LC
authors.lastname: Lasky
mesh_terms: 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
chemical_list: D008775:Methylprednisolone