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Fatal transfusion-associated graft-versus-host disease in an immunocompetent recipient of a volunteer unit of red cells

Authors

  • Darrell Triulzi,

    1. From the Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and the Institute for Transfusion Medicine, Pittsburgh, Pennsylvania.
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  • Rene Duquesnoy,

    1. From the Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and the Institute for Transfusion Medicine, Pittsburgh, Pennsylvania.
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  • Lawrence Nichols,

    1. From the Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and the Institute for Transfusion Medicine, Pittsburgh, Pennsylvania.
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  • Kenneth Clark,

    1. From the Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and the Institute for Transfusion Medicine, Pittsburgh, Pennsylvania.
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  • Drazen Jukic,

    1. From the Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and the Institute for Transfusion Medicine, Pittsburgh, Pennsylvania.
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  • Adriana Zeevi,

    1. From the Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and the Institute for Transfusion Medicine, Pittsburgh, Pennsylvania.
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  • Dennis Meisner

    1. From the Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and the Institute for Transfusion Medicine, Pittsburgh, Pennsylvania.
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Darrell J. Triulzi, MD, Institute for Transfusion Medicine, 3636 Boulevard of the Allies, Pittsburgh, PA 15213; e-mail: dtriulzi@itxm.org.

Abstract

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.

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