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Fatal graft‐versus‐host disease associated with transfusions of HLA‐ matched, HLA‐homozygous platelets from unrelated donors
Author(s) -
Benson K.,
Marks A.R.,
Marshall M.J.,
Goldstein J.D.
Publication year - 1994
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1046/j.1537-2995.1994.34594249057.x
Subject(s) - medicine , immunology , human leukocyte antigen , cytopenia , platelet , blood transfusion , platelet transfusion , gastroenterology , bone marrow , antigen
BACKGROUND : Transfusion‐associated graft‐versus‐host disease (TA‐GVHD) due to blood from HLA‐homozygous related and unrelated blood donors has been described. CASE REPORT: Fatal TA‐GVHD due to the transfusion of HLA‐matched platelets from an unrelated HLA‐homozygous donor is reported. A 61‐year‐old man with a history of diabetes mellitus and myelodysplastic syndrome was diagnosed with acute myelogenous leukemia in November 1991. Induction chemotherapy resulted in aplasia, which was followed by a normocellular marrow with mild dysplasia and continued karyotypic abnormalities. High‐dose chemotherapy was given in a second attempt to achieve complete remission. HLA‐matched platelets were ordered when platelet refractoriness developed. The patient was HLA‐ heterozygous for HLA‐A and ‐B antigens (A2, 29; B37, 44). Over the next 7 days, four unirradiated HLA‐matched plateletpheresis units were transfused; one was probably homozygous for both HLA‐A and ‐B antigens (A2, ‐; B44, ‐) and was transfused first, and three were probably homozygous for an HLA‐B antigen (A2, 29; B44, ‐) and were white cell reduced. No blood relatives served as donors. Seven days after the first HLA‐matched platelet transfusion, fever, chills, and diarrhea developed; 2 days later, a rash was present. Liver enzymes increased markedly. Renal and respiratory failure ensured. A skin biopsy was consistent with GVHD. Despite immunosuppressive therapy, the patient died 19 days after the first HLA‐matched platelet transfusion. CONCLUSION : TA‐GVHD has been recognized in immunocompromised, HLA‐ heterozygous patients receiving blood from blood relatives who are HLA‐ homozygous. patients receiving blood from either blood relatives or non‐ blood relatives who are HLA‐homozygous. This HLA‐heterozygous patient received transfusions of unirradiated, class I HLA‐homozygous platelets, which were specifically ordered as HLA‐matched, and his death was attributed to TA‐GVHD. Consideration should always be given to providing irradiated blood for immunosuppressed patients, especially when HLA‐matched platelets are used, to prevent TA‐GVHD.