T lymphocytes infused from a donor may occasionally proliferate in the recipient and react against host HLA antigens. This can result in a graft-versus-host disease (GVHD) that may be fatal.


Clinical findings:

(1) fever

(2) watery diarrhea

(3) elevated liver function tests

(4) skin rash

(5) pancytopenia secondary to bone marrow aplasia

(6) death usually occurs several weeks after infusion of the T lymphocytes


Patients at risk for develop GVHD:

(1) hematologic malignancy (malignant lymphoma, Hodgkin's disease, acute or chronic leukemia)

(2) solid tissue malignancy

(3) congenital immunodeficiency states, especially affecting cellular immunity

(4) organ transplant recipients

(5) allogeneic or autologous bone marrow transplant recipient

(6) allogeneic or autologous peripheral stem cell transplant recipient

(7) immunosuppression (cytotoxic therapy, irradiation)

(8) neonates, especially if premature or if an exchange transfusion is performed

(7) donor homozygous and recipient heterozygous for an HLA haplotype (occurs more frequently in directed donations from a relative)

(8) intra-uterine transfusion


Products most likely to cause GVHD:

(1) those containing a large number of T lymphocytes (granulocyte products, stem cell product)

(2) HLA-matched transfusion, especially from a relative



(1) Avoid transfusion in susceptible patients.

(2) Gamma irradiation of blood products.

(3) Leukopoor products if irradiation not feasible (reduces risk but does not eliminate).


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