Transfusion-associated graft versus host disease: Difference between revisions

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'''For patient information, click [[Transfusion-associated graft versus host disease (patient information)|here]]'''
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==[[Transfusion-associated graft versus host disease overview|Overview]]==
==[[Transfusion-associated graft versus host disease historical perspective|Historical Perspective]]==
==[[Transfusion-associated graft versus host disease classification|Classification]]==
==[[Transfusion-associated graft versus host disease pathophysiology|Pathophysiology]]==


==[[Transfusion-associated graft versus host disease causes|Causes]]==


'''Transfusion-associated [[graft versus host disease]] (TA-GvHD)''' is a rare complication of [[blood transfusion]], in which the donor [[T cell|T lymphocytes]] mount an immune response against the recipient's lymphoid tissue. Donor lymphocytes are usually identified as foreign and destroyed by the recipient's immune system. However, in situations where the recipient is immunocompromised (inborn [[immunodeficiency]], acquired immunodeficiency, [[malignancy]]), or when the donor is homozygous and the recipient is heterozygous for an [[Human leukocyte antigen|HLA]] [[haplotype]] (as can occur in directed donations from first-degree relatives), the recipient's immune system is not able to destroy the donor lymphocytes. This can result in [[graft versus host disease]].
==[[Transfusion-associated graft versus host disease differential diagnosis|Differentiating Transfusion-associated graft versus host disease from other Diseases]]==


==Epidemiology and Pathogenesis==
==[[Transfusion-associated graft versus host disease epidemiology and demographics|Epidemiology and Demographics]]==
The incidence in immunocompromised patients receiving blood transfusions is estimated to be 0.1 - 1.0%, mortality around 80 - 90%. Mortality is higher in TA-GvHD than in GvHD associated with [[bone marrow transplantation]], where the engrafted lymphoid cells in the [[bone marrow]] are of donor origin; therefore, the immune reaction is not directed against them.


The most common [[cause of death]] in TA-GvHD is [[aplastic anemia]].
==[[Transfusion-associated graft versus host disease risk factors|Risk Factors]]==


==Presentation and Diagnosis==
==[[Transfusion-associated graft versus host disease screening|Screening]]==
===Clinical manifestations===
The clinical presentation the same as in GvHD occurring in other settings, such as bone marrow transplantation. TA-GvHD can develop four to thirty days after the transfusion. Typical symptoms include:
:*[[fever]]
:*erythematous [[maculopapular rash]], which can progress to generalised [[erythroderma]]
:*[[toxic epidermal necrolysis]] in extreme cases


Other symptoms can include cough, abdominal pain, vomiting, and profuse [[diarrhea]] (up to 8 liters/day).
==[[Transfusion-associated graft versus host disease natural history, complications and prognosis|Natural History, Complications and Prognosis]]==


===Laboratory manifestations===
==Diagnosis==
Laboratory findings include [[pancytopenia]], abnormal [[liver function tests|liver enzymes]], and electrolyte imbalance (when diarrhea is present).
[[Transfusion-associated graft versus host disease history and symptoms|History and Symptoms]] | [[Transfusion-associated graft versus host disease physical examination|Physical Examination]] | [[Transfusion-associated graft versus host disease laboratory findings|Laboratory Findings]] | [[Transfusion-associated graft versus host disease biomarker_panel|Biomarker Panel]] | [[Transfusion-associated graft versus host disease chest x ray|Chest X Ray]] | [[Transfusion-associated graft versus host disease HLA_analysis|HLA Analysis]] | [[Transfusion-associated graft versus host disease skin_punch_biopsy|Skin Punch Biopsy]] | [[Transfusion-associated graft versus host disease ultrasound|Ultrasound]] | [[Transfusion-associated graft versus host disease other imaging findings|Other Imaging Findings]] | [[Transfusion-associated graft versus host disease other diagnostic studies|Other Diagnostic Studies]]


===Diagnosis===
==Treatment==
TA-GvHD can be suspected from a [[biopsy]] of the affected skin, and established by [[Human leukocyte antigen|HLA]] analysis of the circulating lymphocytes. This testing can identify circulating lymphocytes with a different HLA type than the tissue cells of the host.
[[Transfusion-associated graft versus host disease medical therapy|Medical Therapy]] | [[Transfusion-associated graft versus host disease surgery|Surgery]] | [[Transfusion-associated graft versus host disease primary prevention|Primary Prevention]] | [[Transfusion-associated graft versus host disease secondary prevention|Secondary Prevention]] | [[Transfusion-associated graft versus host disease cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] |  [[Transfusion-associated graft versus host disease future or investigational therapies|Future or Investigational Therapies]]


==Treatment and Prevention==
==Case Studies==
'''Treatment''' is only supportive, as no available form of therapy has proven effective in treating TA-GvHD.


'''Prevention''' includes [[gamma ray|gamma]] [[irradiation]] of the lymphocyte-containing blood products. This procedure should be performed in transfusions when:
[[Transfusion-associated graft versus host disease case study one|Case #1]]
:* the recipient is immunocompromised
:* the blood components are from a family donor
:* HLA-matched platelets are transferred.
Another means of prevention is the use of third- or fourth-generation [[leukoreduction]] filters, although the efficacy of this procedure has not yet been documented.


==References==
* {{cite journal | author = Anwar M, Bhatti F | title = Transfusion associated graft versus host disease. | journal = J Ayub Med Coll Abbottabad | volume = 15 | issue = 3 | pages = 56-8 | year = | id = PMID 14727344}} ''[http://www.ayubmed.edu.pk/JAMC/PAST/15-3/masood.htm Full text]''
* {{cite journal | author = | title = Transfusion Associated Graft versus Host Disease. | journal = Indian Pediatr | volume = 41 | issue = 12 | pages = 1260-1264 | year = 2004 | id = PMID 15623910}} ''[http://www.indianpediatrics.net/dec2004/1260.pdf Full text (PDF)]''
* Darrell J. Triulzi: [http://www.itxm.org/Archive/tmu9-92.htm Transfusion associated graft vs. host disease and irradiated blood components]
* Eric Kardon, eMedicine: [http://www.emedicine.com/emerg/topic603.htm Transfusion Reactions]


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{{transfusion medicine}}

Latest revision as of 18:27, 6 June 2016

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Overview

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Differentiating Transfusion-associated graft versus host disease from other Diseases

Epidemiology and Demographics

Risk Factors

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