Fatal transfusion-associated graft-versus-host disease in an immunocompetent recipient of a volunteer unit of red cells
Article first published online: 10 APR 2006
Volume 46, Issue 6, pages 885–888, June 2006
How to Cite
Triulzi, D., Duquesnoy, R., Nichols, L., Clark, K., Jukic, D., Zeevi, A. and Meisner, D. (2006), Fatal transfusion-associated graft-versus-host disease in an immunocompetent recipient of a volunteer unit of red cells. Transfusion, 46: 885–888. doi: 10.1111/j.1537-2995.2006.00819.x
- Issue published online: 24 MAY 2006
- Article first published online: 10 APR 2006
- Received for publication September 28, 2005; revision received November 14, 2005, and accepted November 15, 2005.
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 104 × 109 per L. He was readmitted 2 weeks later with a diffuse erythematous rash, a sore throat, and difficulty swallowing. His WBC count was 2.1 × 109 per L, his Hb level was 12.0 g per dL, and his PLT count was 131 × 109 per L. The next day he had worsening cytopenias: WBC count, 1 × 109 per L; Hb level, 10.9 g per dL; PLT count, 104 × 109 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.