TRANSFUSION-ASSOCIATED GRAFT-VERSUS-HOST DISEASE IN AN IMMUNOCOMPETENT INDIVIDUAL FOLLOWING CORONARY-ARTERY BYPASS-GRAFTING

Transfusion associated graft versus host disease (TA-GVHD) is a rare b ut commonly fatal complication of transfusion of cellular blood produc ts, which usually occurs in immunosuppressed individuals following tra nsfusion and subsequent engraftment of viable T lymphocytes. Very rare ly it may arise in apparently immunocompetent individuals. A case is r eported of TA-GVHD in a non-immunocompromised 60 year old white man, r esulting from red cell transfusion after coronary artery bypass grafti ng. HLA typing confirmed homozygosity of the donor for an HLA type sha red by the recipient-the classic scenario for the development of TA-GV HD in immunocompetent individuals. The patient died 21 days after tran sfusion. There is a perceived increased risk of TA-GVHD following bypa ss grafting and other surgical procedures where cardiopulmonary bypass is required. TA-GVHD is probably underreported and the incidence in t he UK is felt to be too low to warrant routine irradiation of cellular products for this group of patients. Clinicians, pathologists, and tr ansfusion centres should be aware of this rare but devastating complic ation of blood transfusion after cardiac surgery.