hematology and oncology
Complications of Transfusion
Graft vs host disease (GVHD)
Transfusion-associated graft-vs-host disease (see also Graft rejection and graft-vs-host disease ) is usually caused by transfusion of products containing immunocompetent lymphocytes to an immunocompromised host. The donor lymphocytes attack host tissues because the host immune system cannot destroy donor lymphocytes. Graft-vs-host disease can occur occasionally in immunocompetent patients if they receive blood from a donor (usually a close relative) who is homozygous for an human leukocyte antigen (HLA) haplotype for which they are heterozygous. Symptoms and signs include fever, rash (centrifugally spreading rash becoming erythroderma with bullae), vomiting, watery and bloody diarrhea, lymphadenopathy, and pancytopenia due to bone marrow aplasia. Jaundice and elevated liver enzyme levels are also common. Graft-vs-host disease occurs 4 to 30 days after transfusion and is diagnosed based on clinical suspicion and skin and bone marrow biopsies. GVHD has>90% mortality because no specific treatment is available. Prevention of graft-vs-host disease is with irradiation (to damage DNA of the donor lymphocytes) of all transfused blood products. It is done When the recipient is immunocompromised (eg, patients with congenital immune deficiency syndromes, hematologic cancers, or hematopoietic stem cell transplants; neonates) When donor blood is obtained from a 1st-degree relative When HLA-matched components, excluding stem cells, are transfused Treatment with corticosteroids and other immunosuppressants, including those used for solid organ transplantation, is not an indication for blood irradiation. 