Canterbury DHB

Context

Transfusion - Associated Graft-Versus-Host Disease

In This Section

Pathophysiology

Risk Groups

Clinical Manifestations

Prevention

Further Reading

Pathophysiology

Transfusion-associated graft versus host disease (GvHD) is a rare complication, most often seen in severely immunocompromised patients. It may also occur in immunocompetent people exposed to blood from a donor with a similar HLA type. In this condition, blood donor lymphocytes which are viable and immunocompetent engraft in the patient. This causes an immune response in which proliferating donor lymphocytes recognise a host/patient tissue as foreign, causing GvHD. This form of the condition is the basis for irradiating directed donor blood given by family members, even if the patient is immunocompetent.

Risk Groups

Clinical Manifestations

Include fever, pancytopenia, diarrhoea, liver dysfunction, rash, and hepatosplenomegaly developing 1-4 weeks post transfusion.

The diagnosis can be confirmed by a skin biopsy showing histological features of graft versus host disease. HLA typing of patient and donor may also be helpful, and chimerism may be detectable using techniques based on DNA testing.

The prognosis of this condition is very poor with mortality in excess of 80%. These patients should be managed by a team with experience in managing GvHD, treatment of which includes immunosuppression and intensive supportive therapy.

Prevention

Preventable by irradiating cellular blood products to at least 25 Gy. Leucodepletion alone is not adequate to eliminate the risk of GvHD.

Patients at risk of GvHD must receive irradiated blood products only. This requirement must be notified to the Blood Bank. The Irradiated Blood Products Alert Form (CDHB) should be used for this purpose.

Further Reading

About this Canterbury DHB document (5128):

Document Owner:

Steve Gibbons (see Who's Who)

Issue Date:

August 2014

Next Review:

August 2016

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 5128