TRANSFUSION-ASSOCIATED GRAFT-VERSUS-HOST DISEASE - REPORT OF 2 FURTHER CASES WITH AN IMMUNOHISTOCHEMICAL ANALYSIS

Transfusion-associated graft-vs.-host disease (tGVHD) is a severe dise ase usually affecting immunocompromised hosts with haematological neop lasia. Two patients with acute leukaemia are reported, who developed f atal tGVHD after blood transfusions. Intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1) and endothelial leucocyte adhesion molecule 1 (ELAM-1) expression and the CD4/CD8 rati o were assessed in lesional skin. ICAM-1 was strongly expressed on epi dermal keratinocytes and endothelial cells (EC) and correlated with HL A-DR staining. VCAM-1 was strongly expressed on EC in the superficial dermal vessels. ELAM-1 stained weakly on EC in some of the superficial vessels. CD8(+) lymphocytes showed prominent epidermotropism; the CD4 /CD8 ratio was 0.8 in case 1 and 1.2 in case 2. Infiltrating cells wer e positive for CD3, CD11a, and CD18. Langerhans' cells were almost com pletely absent. The dermatologist must be aware of the importance of s uch a rare, unexpected and almost always fatal complication of blood t ransfusion, in order to make an early diagnosis. Irradiation of blood products is the only effective way to prevent tGVHD in all subjects at risk.