TRANSFUSION-ASSOCIATED GRAFT-VERSUS-HOST DISEASE IN AN IMMUNOCOMPETENT PATIENT

Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare but increasingly recognized transfusion hazard, described primarily in severely immunocompromised blood recipients. We report a case of fatal TA-GVHD in an immunocompetent patient after resection of a renal adenocarcinoma. Two of the patient's blood donors were children from a consanguineous marriage. HLA studies suggested that one of the patient's children was homozygous for an HLA haplotype shared by the patient and her husband. The transfusion of blood from an HLA-homozygous donor to a haplo-identical HLA-heterozygous recipient can result in TA-GVHD, regardless of the recipient's immune status. Although the probability of this donor-recipient relationship occurring is increased with related donor-recipient pairings, recent data suggest that it may also be significant among unrelated individuals. Although no effective treatment exists, TA-GVHD can be prevented by the irradiation of blood before transfusion. Consideration should be given to wider preventive measures to eliminate this transfusion complication.