Transfusion Associated Graft versus Host Disease (TA-GvHD) is a very rare complication of blood transfusion. It occurs when leucocytes, which are incompatible with the recipient in the graft versus host direction, are transfused into patient who is unable to mount an immune response against the leucocytes because they are compatible in the host versus graft direction or because the patient being immuno-compromised or both. This allows the transfused leucocytes to engraftment and proceed to reject the host. TA-GvHD risk is a high in directed donations from related donors where there is likely to be a haplotype match and is also a high risk in transfusion with HLA matched blood products as a result of the common use homozygous donors. This risk is mitigated by irradiation of all blood products from related donors as well as routine irradiation of all HLA matched platelets to prevent proliferation of leucocytes.
The symptoms of TA-GvHD are similar to those of bone marrow associated GvHD but typically have a much more rapid onset. The key difference with BMT GvHD is that whereas following a bone marrow transplant, the recipient marrow is of donor origin, in TA-GvHD, the the marrow is of recipient origin and is attacked by the TA-GvHD. This leads to a hypocellular bone marrow and ultimately to bone marrow failure. Prognosis for TA-GvHD is poor.
H&I laboratory investigation involves identifying the presence of donor derived cells in affected skin by chimerism studies typically using short tandem repeat (STR) testing. Samples required include patient pre and post transfusion EDTA bloods and skin biopsies from affected and unaffected areas. Blood samples are also required from the implicated donor.
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