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Transfusion-associated graft versus host disease

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Transfusion-associated graft versus host disease (TA-GvHD) is a rare complication of blood transfusion, in which the donor T lymphocytes mount an immune response against the recipient’s lymphoid tissue. Donor lymphocytes are usually identified as foreign and destroyed by the recipient’s immune system. However, in situations where the recipient is immunocompromised (inborn immunodeficiency, acquired immunodeficiency, malignancy), or when the donor is homozygous and the recipient is heterozygous for an HLA haplotype (as can occur in directed donations from first-degree relatives), the recipient’s immune system is not able to destroy the donor lymphocytes. This can result in graft versus host disease.

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Historical Perspective

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Classification

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Pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Pathophysiology

Transfusion-associated graft versus host disease (TA-GvHD) is a rare complication of blood transfusion, in which the donor T lymphocytes mount an immune response against the recipient’s lymphoid tissue. Donor lymphocytes are usually identified as foreign and destroyed by the recipient’s immune system. However, in situations where the recipient is immunocompromised (inborn immunodeficiency, acquired immunodeficiency, malignancy), or when the donor is homozygous and the recipient is heterozygous for an HLA haplotype (as can occur in directed donations from first-degree relatives), the recipient’s immune system is not able to destroy the donor lymphocytes. This can result in graft versus host disease.

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Causes

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Differentiating Transfusion-associated graft versus host disease from other Diseases

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Epidemiology and Demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Epidemiology and Demographics

The incidence in immunocompromised patients receiving blood transfusions is estimated to be 0.1 – 1.0%, mortality around 80 – 90%. Mortality is higher in TA-GvHD than in GvHD associated with bone marrow transplantation, where the engrafted lymphoid cells in the bone marrow are of donor origin; therefore, the immune reaction is not directed against them.

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Risk Factors

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Screening

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Natural History, Complications and Prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Complications

The most common cause of death in TA-GvHD is aplastic anemia.

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Diagnosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Biomarker Panel | Chest X Ray | HLA Analysis | Skin Punch Biopsy | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case Studies

Case #1


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