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Fatal transfusion‐associated graft‐versus‐host disease in an immunocompetent recipient of a volunteer unit of red cells
Author(s) -
Triulzi Darrell,
Duquesnoy Rene,
Nichols Lawrence,
Clark Kenneth,
Jukic Drazen,
Zeevi Adriana,
Meisner Dennis
Publication year - 2006
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2006.00819.x
Subject(s) - medicine , gastroenterology , complication , surgery , white blood cell , chills , platelet , blood transfusion , hemoglobin , sore throat
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 × 10 9 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 × 10 9 per L, his Hb level was 12.0 g per dL, and his PLT count was 131 × 10 9 per L. The next day he had worsening cytopenias: WBC count, 1 × 10 9 per L; Hb level, 10.9 g per dL; PLT count, 104 × 10 9 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.