Transfusion-associated graft-versus-host disease: a case report

Abstract

Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare complication of blood transfusion resulting from donor’s T-lymphocyte engrafts, proliferates and attacks to recipient’s cells. Clinical manifestations include fever, rash, hepatomegaly, liver dysfunction and pancytopenia occurring up to 6 weeks after transfusion. We present here a case of TA-GVHD in an infant with severe combined immunodeficiency (SCID).

A 3-month-old male infant at a province hospital presented fever, anemia and tachypnea and subsequently received a diagnosis of severe pneumonia. Non-irradiated leukocyte poor red cells (LPRC) was given for anemia correction. He was transferred to the King Chulalongkorn Memorial Hospital 2 days after the transfusion and symptoms deteriorated. Given the history of his two older brothers, who died of pneumonia at the age of 3 months, peripheral blood flow cytometry was performed showing the absence of B/T lymphocytes and NK cells. He was diagnosed with SCID at the age of 4 months. At six weeks after hospital admission, he developed hepatomegaly with elevated liver enzymes and pancytopenia. HLA typing from the patients’ peripheral blood
was made and the results showed a total mismatch with his parents. In addition, HLA typing from his buccal epithelial cells was matched with his parents. Subsequently, he was diagnosed with TA-GVHD and died of severe pneumonia and respiratory failure at age 6 months.

Clinical manifestations of the patient that occurred within 6 weeks after blood transfusion met the diagnostic criteria of TA-GVHD. The HLA typing result from his peripheral blood might have resulted from active T-lymphocytes in transfused nonirradiated LPRC. Transfusion with irradiated blood products can prevent the risk of TA-GVHD because radiation is used to deactivate T-lymphocytes in blood products.