BACKGROUND: Transfusion-associated graft-versus-host disease (TAGVHD) is a lethal complication of transfusion of nonirradiated cellular blood components to a susceptible recipient. CASE REPORT: An 82-year-old man underwent cardiac surgery during which he received 6 units of red cells (RBCs) and a 6-unit pool of platelets (PLTs). He was discharged with a normal white blood cell (WBC) count and hemoglobin (Hb) level and a PLT count of 104x10(9) per L. He was readmitted 2 weeks later with a diffuse erythematous rash, a sore throat, and difficulty swallowing. His WBC count was 2.1x10(9) per L, his Hb level was 12.0 g per dL, and his PLT count was 131x10(9) per L. The next day he had worsening cytopenias: WBC count, 1x10(9) per L; Hb level, 10.9 g per dL; PLT count, 104x10(9) per L. He also had diarrhea. A marrow biopsy showed a severe hypoplasia without evidence of malignancy. A skin biopsy showed Grade II GVHD. The patient worsened and despite aggressive therapy he expired on Postoperative Day 42. DNA-based HLA testing of the 12 blood donors was performed. One of the RBC donors was found to be homozygous for an HLA Class I and Class II haplotype in the patient. CONCLUSION: This is the first reported case in the United States of fatal TAGVHD from RBCs in an immunocompetent patient who received a randomly selected unit of RBCs from a donor who was homozygous for a shared HLA haplotype. The policy of selective irradiation should be reexamined.
BACKGROUND: Transfusion-associated graft-versus-host disease (TAGVHD) is a lethal complication of transfusion of nonirradiated cellular blood components to a susceptible recipient. CASE REPORT: An 82-year-old man underwent cardiac surgery during which he received 6 units of red cells (RBCs) and a 6-unit pool of platelets (PLTs). He was discharged with a normal white blood cell (WBC) count and hemoglobin (Hb) level and a PLT count of 104x10(9) per L. He was readmitted 2 weeks later with a diffuse erythematous rash, a sore throat, and difficulty swallowing. His WBC count was 2.1x10(9) per L, his Hb level was 12.0 g per dL, and his PLT count was 131x10(9) per L. The next day he had worsening cytopenias: WBC count, 1x10(9) per L; Hb level, 10.9 g per dL; PLT count, 104x10(9) per L. He also had diarrhea. A marrow biopsy showed a severe hypoplasia without evidence of malignancy. A skin biopsy showed Grade II GVHD. The patient worsened and despite aggressive therapy he expired on Postoperative Day 42. DNA-based HLA testing of the 12 blood donors was performed. One of the RBC donors was found to be homozygous for an HLA Class I and Class II haplotype in the patient. CONCLUSION: This is the first reported case in the United States of fatal TAGVHD from RBCs in an immunocompetent patient who received a randomly selected unit of RBCs from a donor who was homozygous for a shared HLA haplotype. The policy of selective irradiation should be reexamined.
Authors: Rachael P Jackman; Xutao Deng; Douglas Bolgiano; Garth H Utter; Cathy Schechterly; Mila Lebedeva; Eva Operskalski; Naomi L Luban; Harvey Alter; Michael P Busch; Sherrill J Slichter; Philip J Norris Journal: Transfusion Date: 2013-06-30 Impact factor: 3.157
Authors: Lucas Sacchini Del Lama; Evamberto Garcia de Góes; Paulo César Dias Petchevist; Edson Lara Moretto; José Carlos Borges; Dimas Tadeu Covas; Adelaide de Almeida Journal: PLoS One Date: 2013-06-07 Impact factor: 3.240