TA-GVHD, a Fatal Complication Following Blood Transfusion from a First-Degree Relative

Malladi, Subbalaxmi V. S.; Paul, Roshni T; Chandra, Naval; Rao, Neha; Raju, Satyanarayana Yadati

doi:10.1007/s13224-012-0189-x

Cited by 5 publications

(3 citation statements)

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“…It is understood that having a donor from family member is actually less preferable compared to unrelated donors -as homozygosity of HLA types is more common to occur between first-degree family members, which may trigger transfusion-associated graft-versus-host-disease (TA-GVHD). 14,15 Regardless, this was the safest blood option we were able to provide concerning its kidd-incompatibility circumstances.…”

Section: Discussionmentioning

confidence: 99%

The safety of kidd-incompatible blood transfusion in a restricted setting: a case report

Marpaung¹

2019

hsji

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Latar belakang: Protein Kidd merupakan transporter urea pada sel darah merah. Walaupun jarang, adanya antibodi terhadap antigen ini dapat menyebabkan reaksi transfusi dan hemolytic disease of the newborn. Keberadaan anti-Jka dan anti-Jkb cukup jarang ditemukan pada pemeriksaan identifikasi antibodi pasien. Studi ini melaporkan kasus pasien dengan keberadaan anti-Jka and anti-Jkb, yang mendapat darah dengan kadar aglutinasi terendah pada kondisi dimana darah kompatibel sulit didapat sementara tindakan transfusi sangat dibutuhkan segera. Penyajian Kasus: Wanita, 36 tahun, G4P3A0, datang dengan perdarahan vaginam sejak sebulan terakhir. Dari hasil pemeriksaan USG, didapatkan adanya mola hidatidosa. Pasien memerlukan terapi kuret segera setelah anemia terkoreksi (Hb 8.3 g/dL). Pada uji kecocokan pre-transfusi dengan prosedur skrining antibodi yang dilanjutkan dengan identifikasi antibodi, ditemukan anti-Jka dan anti-Jkb. Dari setidaknya 50 darah donor yang dilakukan uji kecocokan, tidak ditemukan darah yang kompatibel, sehingga pasien diputuskan untuk mendapat transfusi menggunakan darah inkompatibel dengan derajat aglutinasi terendah (level 2) dari 5 level, disertai dengan pemantauan ketat terhadap potensi terjadinya reaksi transfusi. Demam dan pruritus dilaporkan dalam 24 jam setelah transfusi, dan membaik setelah pemberian injeksi difenhidramin, deksametason, dan parasetamol. Kesimpulan: Transfusi dengan darah yang inkompatibel merupakan pilihan terakhir bila tidak ditemukan darah donor yang kompatibel. Reaksi transfusi merupakan efek yang sulit dihindari, tetapi dapat dilakukan pemantuan ketat. Pemilihan darah dengan level aglutinansi terendah adalah keputusan terbaik, mengingat tindakan medis diperlukan segera untuk menyelamatkan nyawa. Pada kasus ini, pasien mendapat tatalaksana optimal dari aspek tindakan operasi dan respon transfusi, yang ditunjukkan melalui kenaikan nilai Hb yang bermakna. Sementara itu, efek samping reaksi transfusi yang muncul hanya ringan dan dapat ditanggulangi dengan pemberian obatobatan. (Health Science Journal of Indonesia 2019;10(2):137-9) Kata kunci: reaksi transfusi, inkompatibilitas, kelompok darah Kidd Abstract Background: Kidd protein is red blood cell’s (RBC) major urea transporter. Albeit rare, the presence of antibodies against Kidd antigen may cause significant hemolytic transfusion reaction and hemolytic disease of the newborn. Yet, anti-Jka and anti-Jkb are rare to be discovered during antibody identification. This paper reported “bestmatched” transfusion practice in a patient with anti-Jka and anti-Jkb, where compatible PRC cannot be found, but transfusion is urgently needed. Case Presentation: A 36 years old, G4P3A0 female, came with continuous vaginal bleeding for the past one month before admission. USG revealed hydatidiform mole. She needed immediate curettage following correction of her anemia (Hb 8.3g/dL). After antibody screening procedure followed by antibody identification, we found a positive anti-Jka and anti-Jkb in her blood sample. At least 50 blood donors were tested for compatibility and none was a match. She was then transfused with the lowest agglutination blood available (level 2 of 5 levels), with a closed monitoring to anticipate the possibility of transfusion reaction development. Fever and pruritus transpired within 24 hours post transfusion and it resolved following diphenhydramine, dexamethasone, and paracetamol injection. Conclusion: Incompatible blood transfusion is the last option when compatible blood cannot be found. The development of transfusion reaction is inevitable, but it can be anticipated by closed monitoring. In restricted setting, blood transfusion with the lowest level of agglutination is acceptable when transfusion is imperative. In this case, the patient got optimal treatment in term of the medical surgery and transfusion response, which was shown by the significant increase of Hb level. Meanwhile, the adverse transfusion reaction was only mild, and could be treated with medicine. (Health Science Journal of Indonesia 2019;10(2):137-9) Keywords: Transfusion reaction, incompatibility, Kidd blood group

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Section: Discussionmentioning

confidence: 99%

The safety of kidd-incompatible blood transfusion in a restricted setting: a case report

Marpaung¹

2019

hsji

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“…This finding might result from the lymphocyte insufficiency in peripheral blood, probably because that donor lymphocytes were easier to be rejected as foreign bodies (18) . Immunosuppressive regimens involving corticosteroids, antithymocyte globulin (ATG), and immune inhibitors (CsA, CTX) have yielded poor results with few documented survivors (19,20) . Some scholars even believe that "there is currently no treatment" (2) .…”

Section: Discussionmentioning

confidence: 99%

Anti-CD3 Antibody Ameliorates Transfusion-Associated Graft-Versus-Host Disease in a Chemotherapy-Based Mouse Model With Busulfan and Fludarabine

Song

et al. 2017

Braz. arch. biol. technol.

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“…The bone marrow biopsy reported hypocellularity, scattered histiocytes and erythrophagocytosis in TA-GVHD. 4,6 A definitive diagnosis of TAGVHD is possible by documentation of donor-specific cells, or DNA, in the blood or tissues of the recipient by various molecular methods. 7 Hemophagocytosis and marked stromal changes seen in the trephine biopsy resulting in pancytopenia were seen in a fatal outcome TAGVHD case.…”

mentioning

confidence: 99%

Bone marrow changes in a fatal case of transfusion associated—Graft versus host disease

Kumawat

Goyal²,

Rani³

2022

Transfusion Medicine

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TA-GVHD, a Fatal Complication Following Blood Transfusion from a First-Degree Relative

Cited by 5 publications

References 1 publication

The safety of kidd-incompatible blood transfusion in a restricted setting: a case report

The safety of kidd-incompatible blood transfusion in a restricted setting: a case report

Anti-CD3 Antibody Ameliorates Transfusion-Associated Graft-Versus-Host Disease in a Chemotherapy-Based Mouse Model With Busulfan and Fludarabine

Bone marrow changes in a fatal case of transfusion associated—Graft versus host disease

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