Transfusion-associated graft-vs-host disease - A fatal case caused by blood from an unrelated HLA homozygous donor

Transfusion-associated graft-vs-host disease (TA-GVHD) is a rare complicati on of transfusion. We report fatal TA-GVHD in a 63-year-old coronary artery bypass patient of European descent after an RBC transfusion from an unrela ted donor. The patient had mild lymphocytopenia and received 2 80-mg doses of methylprednisolone and 7 units of RBCs. On day 14 after the transfusion, he had fever elevated liver enzyme levels, and a macular rash. Pancytopeni a and bone marrow aplasia developed. On day 26, he had a massive gastrointe stinal hemorrhage and died. At autopsy, histopathologic findings of the ski n, liver; bone marrow, and gastrointestinal tract were consistent with TA-G VHD. One donor of the transfused RBCs (3 days old at transfusion) had a 1-w ay HLA match with the patient. A method using multiplex polymerase chain re action is presented. This patient with TA-GVHD and mild immune suppression suggests that blood component irradiation guidelines may need to be reevalu ated.