Fatal graft versus host disease following a blood transfusion in a child with neuroblastoma.

A 2-year-old boy who was receiving intensive chemotherapy for advanced neuroblastoma developed fatal graft versus host disease following administration of a unit of packed red blood cells from an unrelated donor. Graft versus host disease was documented by demonstrating human leukocyte antigen identity between the transfusion donor and the patient's peripheral circulating lymphocytes. Nonirradiated packed red blood cells contain viable lymphocytes and pose a risk to the immunosuppressed cancer patient.