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| field = [[Hematology]] |
| field = [[Hematology]] |
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| synonyms = TA-GvHD |
| synonyms = TA-GvHD |
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'''Transfusion-associated graft-versus-host disease''' ('''TA-GvHD''') is a rare complication of [[blood transfusion]], in which the immunologically competent donor [[T cell|T lymphocytes]] mount an immune response against the recipient's lymphoid tissue.<ref name="urlComplications of Transfusion: Transfusion Medicine: Merck Manual Professional">{{cite web |url=http://www.merck.com/mmpe/sec11/ch146/ch146e.html#sec11-ch146-ch146d-1107 |title=Complications of Transfusion: Transfusion Medicine: Merck Manual Professional | |
'''Transfusion-associated graft-versus-host disease''' ('''TA-GvHD''') is a rare complication of [[blood transfusion]], in which the immunologically competent donor [[T cell|T lymphocytes]] mount an immune response against the recipient's lymphoid tissue.<ref name="urlComplications of Transfusion: Transfusion Medicine: Merck Manual Professional">{{cite web |url=http://www.merck.com/mmpe/sec11/ch146/ch146e.html#sec11-ch146-ch146d-1107 |title=Complications of Transfusion: Transfusion Medicine: Merck Manual Professional |access-date=2009-02-09}}</ref> These donor lymphocytes engraft, recognize recipient cells as foreign and mount an immune response against recipient tissues.<ref name=":1">{{cite journal | vauthors = Savage WJ | title = Transfusion Reactions | journal = Hematology/Oncology Clinics of North America | volume = 30 | issue = 3 | pages = 619–634 | date = June 2016 | pmid = 27113000 | doi = 10.1016/j.hoc.2016.01.012 }}</ref> Donor lymphocytes are usually identified as foreign and destroyed by the recipient's immune system. However, in situations where the recipient is severely immunocompromised, or when the donor and recipient [[Human leukocyte antigen|HLA]] type is similar (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 transfusion associated graft-versus-host disease. This is in contrast with organ/tissue transplant associated [[Graft-versus-host disease|GvHD]], where matching HLA reduces the incident of the complication.<ref>{{cite book | vauthors = Vaillant AA, Modi P, Mohammadi O | chapter = Graft Versus Host Disease |date=2022 | chapter-url=http://www.ncbi.nlm.nih.gov/books/NBK538235/ |title =StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30855823 |access-date=2023-02-02 }}</ref> |
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==Signs and symptoms== |
==Signs and symptoms== |
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The clinical presentation is the same as [[Graft-versus-host disease|GvHD]] occurring in other settings, such as bone marrow transplantation. TA-GvHD can develop |
The clinical presentation is the same as [[Graft-versus-host disease|GvHD]] occurring in other settings, such as bone marrow transplantation. TA-GvHD can develop two days to six weeks after the transfusion.<ref name=":0">{{Cite web|url=https://www.cdc.gov/nhsn|title=National Healthcare Safety Network (NHSN) |date=2017-12-29|website=www.cdc.gov|language=en-us|access-date=2018-09-18}}</ref> Typical symptoms include:<ref name=":0" /> |
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:*[[fever]] |
:*[[fever]] |
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:*diarrhea |
:*diarrhea |
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Other symptoms can include cough, abdominal pain, dyspnea and vomiting.<ref>{{cite journal | vauthors = Patel KK, Patel AK, Ranjan RR, Shah AP | title = Transfusion associated graft versus host disease following whole blood transfusion from an unrelated donor in an immunocompetent patient | journal = Indian Journal of Hematology & Blood Transfusion | volume = 26 | issue = 3 | pages = 92–95 | date = September 2010 | pmid = 21886390 | pmc = 3002081 | doi = 10.1007/s12288-010-0028-0 }}</ref> |
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Other symptoms can include cough, abdominal pain, vomiting, and profuse [[diarrhea]] (up to 8 [[liter]]s/day). |
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==Diagnosis== |
==Diagnosis== |
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Laboratory findings include [[pancytopenia]], marrow aplasia, abnormal [[liver function tests|liver enzymes]], and electrolyte imbalance (when diarrhea is present). |
Laboratory findings include [[pancytopenia]], marrow aplasia, abnormal [[liver function tests|liver enzymes]], and electrolyte imbalance (when diarrhea is present).{{citation needed|date=December 2021}} |
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TA-GvHD can be suspected from a [[biopsy]] of the affected skin or liver,<ref name=":0" /> and established by [[Human leukocyte antigen|HLA]] analysis of the circulating lymphocytes. This testing can identify circulating lymphocytes with a different HLA type than the tissue cells of the host. |
TA-GvHD can be suspected from a [[biopsy]] of the affected skin or liver,<ref name=":0" /> and established by [[Human leukocyte antigen|HLA]] analysis of the circulating lymphocytes. This testing can identify circulating lymphocytes with a different HLA type than the tissue cells of the host.{{citation needed|date=December 2021}} |
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In 2023, the first case of fetal-induced GvHD was reported in the New England Journal of Medicine.<ref>[https://www.nejm.org/doi/full/10.1056/NEJMc2307669 A Case of Fetal-Induced Graft-versus-Host Disease]</ref> |
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==Prevention== |
==Prevention== |
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Prevention includes [[gamma ray|gamma]] [[irradiation]] of the lymphocyte-containing blood components such as red blood cells, platelets and granulocytes. Irradiated blood components should be issued in the following situations:<ref>{{Cite book|title=Technical manual|date=2014|publisher=American Association of Blood Banks| |
Prevention includes [[gamma ray|gamma]] [[irradiation]] of the lymphocyte-containing blood components such as red blood cells, platelets and granulocytes. Irradiated blood components should be issued in the following situations:<ref>{{Cite book|title=Technical manual|date=2014|publisher=American Association of Blood Banks| vauthors = Fung MK, Grossman BJ, Hillyer CD, Westhoff CM | isbn=978-1563958885|edition= 18th|location=Bethesda, Md.|oclc=881812415}}</ref> |
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:* Intrauterine transfusions |
:* Intrauterine transfusions |
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==Epidemiology== |
==Epidemiology== |
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The incidence of TA-GvHD in immunocompromised patients receiving blood transfusions is estimated to be 0. |
The incidence of TA-GvHD in immunocompromised patients receiving blood transfusions is estimated to be 0.1–1.0%, and mortality around 80–90%. Mortality is higher in TA-GvHD than in GvHD associated with [[bone marrow transplantation]], where the [[engraft]]ed lymphoid cells in the [[bone marrow]] are of donor origin (in autotransplant) and therefore the immune reaction is not directed against them.{{citation needed|date=December 2021}} |
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The most common [[causes of death]] in TA-GvHD are infections and hemorrhages secondary to pancytopenia and liver dysfunction. |
The most common [[causes of death]] in TA-GvHD are infections and hemorrhages secondary to pancytopenia and liver dysfunction.{{citation needed|date=December 2021}} |
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==References== |
== References == |
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{{Reflist}} |
{{Reflist}} |
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== Further reading == |
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{{refbegin}} |
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⚫ |
* {{cite journal | vauthors = |
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* {{cite journal | |
* {{cite journal | vauthors = Anwar M, Bhatti FA | title = Transfusion associated graft versus host disease | journal = Journal of Ayub Medical College, Abbottabad | volume = 15 | issue = 3 | pages = 56–58 | year = 2003 | pmid = 14727344 | url = http://www.ayubmed.edu.pk/JAMC/PAST/15-3/masood.htm }} |
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⚫ | * {{cite journal | vauthors = Gupta A, Bansal D, Dass R, Das A | title = Transfusion associated graft versus host disease | journal = Indian Pediatrics | volume = 41 | issue = 12 | pages = 1260–1264 | date = December 2004 | pmid = 15623910 | url = http://www.indianpediatrics.net/dec2004/1260.pdf }} |
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* Darrell J. Triulzi: [https://web.archive.org/web/20060722003215/http://www.itxm.org/Archive/tmu9-92.htm Transfusion associated graft vs. host disease and irradiated blood components] |
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* {{cite web | vauthors = Triulzi DJ | date = September 1992 | url = http://www.itxm.org/Archive/tmu9-92.htm | title = Transfusion associated graft vs. host disease and irradiated blood components | archive-url = https://web.archive.org/web/20060722003215/http://www.itxm.org/Archive/tmu9-92.htm | archive-date = 2006-07-22 }} |
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* Eric Kardon, eMedicine: [http://www.emedicine.com/emerg/topic603.htm Transfusion Reactions] |
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* {{cite journal | vauthors = Kardon E | journal = EMedicine | url = https://emedicine.medscape.com/article/780074-overview | title = Transfusion Reactions | date = 8 July 2022 }} |
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{{refend}} |
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{{Medical resources |
{{Medical resources |
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| ICD10 = {{ICD10|T|80|8|t|80}} |
| ICD10 = {{ICD10|T|80|8|t|80}} |
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| ICD9 = {{ICD9|999.8}} |
| ICD9 = {{ICD9|999.8}} |
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}} |
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Transfusion-associated graft-versus-host-disease | |
---|---|
Other names | TA-GvHD |
Specialty | Hematology |
Transfusion-associated graft-versus-host disease (TA-GvHD) is a rare complication of blood transfusion, in which the immunologically competent donor T lymphocytes mount an immune response against the recipient's lymphoid tissue.[1] These donor lymphocytes engraft, recognize recipient cells as foreign and mount an immune response against recipient tissues.[2] Donor lymphocytes are usually identified as foreign and destroyed by the recipient's immune system. However, in situations where the recipient is severely immunocompromised, or when the donor and recipient HLA type is similar (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 transfusion associated graft-versus-host disease. This is in contrast with organ/tissue transplant associated GvHD, where matching HLA reduces the incident of the complication.[3]
The clinical presentation is the same as GvHD occurring in other settings, such as bone marrow transplantation. TA-GvHD can develop two days to six weeks after the transfusion.[4] Typical symptoms include:[4]
Other symptoms can include cough, abdominal pain, dyspnea and vomiting.[5]
Laboratory findings include pancytopenia, marrow aplasia, abnormal liver enzymes, and electrolyte imbalance (when diarrhea is present).[citation needed]
TA-GvHD can be suspected from a biopsy of the affected skin or liver,[4] and established by HLA analysis of the circulating lymphocytes. This testing can identify circulating lymphocytes with a different HLA type than the tissue cells of the host.[citation needed]
In 2023, the first case of fetal-induced GvHD was reported in the New England Journal of Medicine.[6]
Prevention includes gamma irradiation of the lymphocyte-containing blood components such as red blood cells, platelets and granulocytes. Irradiated blood components should be issued in the following situations:[7]
Treatment is supportive. No available form of therapy has proven effective in treating TA-GvHD and it is fatal in more than 90% of cases.[2]
The incidence of TA-GvHD in immunocompromised patients receiving blood transfusions is estimated to be 0.1–1.0%, and 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 (in autotransplant) and therefore the immune reaction is not directed against them.[citation needed]
The most common causes of death in TA-GvHD are infections and hemorrhages secondary to pancytopenia and liver dysfunction.[citation needed]
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Blood products |
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General concepts |
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Methods |
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Tests |
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Transfusion reactions and adverse effects |
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Blood group systems |
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