Radiation Oncology/Miscellaneous/Transfusion-Associated Graft-versus-Host Disease

  • Rare complication of blood transfusion
  • Immunologically competent donor T lymphocytes mount an immune response against the recipient's lymphoid tissue
  • Can develop 2 days to 6 weeks after the transfusion
  • Typical symptoms include fever, erythematous maculopapular rash, which can progress to generalised erythroderma, toxic epidermal necrolysis in extreme cases, hepatomegaly, cough, abdominal pain, vomiting, and profuse diarrhea (up to 8 liters/day)
  • Laboratory findings include pancytopenia, marrow aplasia, abnormal liver enzymes, and electrolyte imbalance (when diarrhea is present)
  • TA-GvHD can be suspected from a biopsy of the affected skin or liver and established by HLA analysis of the circulating lymphocytes
  • Prevention includes gamma irradiation of the lymphocyte-containing blood components such as red blood cells, platelets and granulocytes
  • Dose of 2500 cGy is required to completely inactivate T cells
  • Treatment is supportive:
    1. No available form of therapy has proven effective
    2. TA-GvHD is fatal in more than 90% of cases