| Transfusion-associated graft-versus-host-disease | |
|---|---|
| Other names | TA-GvHD |
| Specialty | Hematology |
Transfusion-associated graft-versus-host disease (TA-GvHD) is a rare complication ofblood transfusion, in which the immunologically competent donorT lymphocytes mount an immune response against the recipient's lymphoid tissue.[1] These donor lymphocytes engraft, recognize recipient cells as foreign and mount an immune response against recipient tissues.[2] Donor lymphocytes are usually identified as foreign and destroyed by the recipient's immune system. However, in situations where the recipient is severely immunocompromised, or when the donor and recipientHLA type is similar (as can occur in directed donations from first-degree relatives), the recipient's immune system is not able to destroy the donor lymphocytes. This can result in transfusion associated graft-versus-host disease. This is in contrast with organ/tissue transplant associatedGvHD, where matching HLA reduces the incident of the complication.[3]
The clinical presentation is the same asGvHD occurring in other settings, such as bone marrow transplantation. TA-GvHD can develop two days to six weeks after the transfusion.[4] Typical symptoms include:[4]
Other symptoms can include cough, abdominal pain, dyspnea and vomiting.[5]
Laboratory findings includepancytopenia, marrow aplasia, abnormalliver enzymes, and electrolyte imbalance (when diarrhea is present).[citation needed]
TA-GvHD can be suspected from abiopsy of the affected skin or liver,[4] and established byHLA analysis of the circulating lymphocytes. This testing can identify circulating lymphocytes with a different HLA type than the tissue cells of the host.[citation needed]
In 2023, the first case of fetal-induced GvHD was reported in the New England Journal of Medicine.[6]
Prevention includesgammairradiation of the lymphocyte-containing blood components such as red blood cells, platelets and granulocytes. Irradiated blood components should be issued in the following situations:[7]
Treatment is supportive. No available form of therapy has proven effective in treating TA-GvHD and it is fatal in more than 90% of cases.[2]
The incidence of TA-GvHD in immunocompromised patients receiving blood transfusions is estimated to be 0.1–1.0%, and mortality around 80–90%. Mortality is higher in TA-GvHD than in GvHD associated withbone marrow transplantation, where theengrafted lymphoid cells in thebone marrow are of donor origin (in autotransplant) and therefore the immune reaction is not directed against them.[citation needed]
The most commoncauses of death in TA-GvHD are infections and hemorrhages secondary to pancytopenia and liver dysfunction.[citation needed]