Transfusion Associated Graft Versus Host Disease Following Whole Blood Transfusion from an Unrelated Donor in an Immunocompetent Patient

Abstract

Graft-versus-host disease (GVHD) is a well-known complication of allogeneic bone marrow transplantation. Transfusion associated graft-versus-host disease (TA-GVHD) is much less common and nearly uniformly fatal complication of blood transfusion. The risk factors underlying the development of TA- GVHD are incompletely defined, but it is commonly seen in individuals with congenital or acquired immunodeficiency, transfusions from blood relatives, intrauterine transfusions and HLA-matched platelet transfusions. Diagnosis of TA-GVHD may be difficult at a time due to rarity in occurrence and overlapping clinical features with various infections and drug reactions. We describe a case of transfusion-associated GVHD that occurred after transfusion of whole blood from unrelated donor in an immunocompetent patient.

Transfusion-Associated Graft Versus Host Disease in the Immunocompetent Patient

“…Additionally, there is the aforementioned patient with hysterectomy who developed GVHD. 12 These cases indicate the presence of other risk factors.…”

“…In addition to the cases described above, a case of TA-GVHD in an immunocompetent patient who underwent a vaginal hysterectomy was described in India in 2010. 12 She received 2 units of stored whole blood from an unrelated donor, 1 day prior to surgery. She returned to the hospital 2 weeks following surgery with nausea/vomiting, diarrhea, and skin rash.…”

“…It has been reported following a variety of other procedures, such as cholecystectomy, hysterectomy, cesarean section, and knee replacement. 12,18,24,25 Specifically, in 1991, a case of TA-GVHD was described in the United States of a presumed immunocompetent patient with rheumatoid arthritis who underwent uncomplicated elective knee replacement. 18 She received 2 units of blood during surgery.…”

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

“…Transfusion-associated viruses like HIV, hepatitis B, and cytomegalovirus can cause similar type of illness. Dengue fever and leptospirosis are another important differential diagnosis for a person living in endemic area, but such intense exfoliation of shin and oral thrush are unlikely in both [2].…”

Graft versus host disease associated with blood transfusion

“…This kind of mishap is likely to occur when there is limited genetic variability in the population, as in Japan, or when the blood donor is a family member, particularly if there is a high rate of consanguinity, thus causing shared HLA antigens, such as in rural Turkey [4] or on the subcontinent [5]. Unlike transplantion associated GVHD, transfusion associated GVHD is almost always fatal [6][7][8] . This is because apart from attacking the skin, liver and GI tract, lymphocytes in the donor blood also attack the host's bone marrow, causing aplasia.…”