title: Fatal transfusion-associated graft-versus-host disease with concomitant immune hemolysis in a group A combat trauma patient resuscitated with group O fresh whole blood.
abstract: Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare but well-established fatal complication of blood transfusion. It can occur in immunocompetent patients when they receive transfusions from human leukocyte antigen-haploidentical donors who have lymphocytes with antigens that are not recognized as foreign by the host, but that recognize the host's tissues as foreign. It is generally viewed as a T-cell-mediated process. Graft-induced immune hemolysis or passenger lymphocyte syndrome is a well-described complication of marrow or solid organ transplantation in which immune competent donor B cells produce alloantibodies to recipient red blood cell (RBC) antigens and cause hemolysis of the recipient's RBCs. It is generally considered as a separate process from GVHD, although it could be considered a type of GVHD. Despite the theoretical possibility of both a B-cell and T-cell component to TA-GVHD, detection of a humoral antibody in cases of acute TA-GVHD has not been described. We describe the clinical course and laboratory evaluation of a group A combat trauma patient who was acutely resuscitated with group O fresh whole blood and RBCs and group AB fresh-frozen plasma who experienced the onset of the clinical symptoms of TA-GVHD as well as the onset of hemolysis due to donor-derived anti-A in his plasma 11 days after transfusion.
authors: Department of Laboratory Medicine, National Naval Medical Center, Bethesda, MD 20889, USA. colleen.gilstad@med.navy.mil
authors: Colleen
authors: C
authors: Gilstad
authors: Mark
authors: M
authors: Roschewski
authors: Justin
authors: J
authors: Wells
authors: Andrew
authors: A
authors: Delmas
authors: Jeffrey
authors: J
authors: Lackey
authors: Paul
authors: P
authors: Uribe
authors: Christian
authors: C
authors: Popa
authors: Timothy
authors: T
authors: Jardeleza
authors: Stuart
authors: S
authors: Roop
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000209:etiology*; D006461:Hemolysis; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D065227:Transfusion Reaction; D014857:Warfare
chemical_list: D000017:ABO Blood-Group System