Transfusion-associated graft versus host disease

Timing: within 4 to 21 days of transfxn
Risk: immunocompromised, especially with B-cell mediated malignancies, ALL, Hodgkin lymphoma, patients receiving immunosuppressive regimens, congenital immunodef syndromes, transfusion from relatives (partial HLA matching)
Pathophys: donor lymphocytes proliferate and attack host (severe compromise of host lymphocyte function or can’t detect donor lymphocytes as foreign)
Symptoms: maculopapular rash, gastrointestinal disturbance, and jaundice/hepatosplenomegaly
Treatment:
Prevention: Irradiation of transfused blood products in immunodeficient patients
Hematopoietic stem cell donor (often fatal before suitable donor found)
+/- T-cell immunosuppression