Transfusion-associated graft-versus-host disease (TA-GVHD) is a life-threatening complication that may occur in immunocompromised patient following the transfusion of cellular blood components (red cell concentrates, platelet concentrates, granulocyte concentrates).
In rare circumstances, TA-GVHD may occur in immunocompetent patients who receive HLA-matched blood components or transfusions from first-degree family members (namely, parents, children, siblings) due to shared specificities at the major histocompatibility complex. For example, if the patient is heterozygous at an HLA locus and the donor is homozygous for one of the corresponding loci, the immunocompetent patient will not recognize the donor as foreign.
The incidence of TA-GVHD is unknown but rare.
The clinical syndrome consists of fever, skin rash, diarrhea, hepatic dysfunction, and bone marrow aplasia, typically appearing eight to ten days after transfusion.
The outcome has a high fatality rate, with hemorrhage and infection as the most common causes of death.
TA-GVHD results when transfused T lymphocytes present in cellular blood components engraft, multiply, and react against the tissues of the recipient.
Transfusion services should have clear policies describing the required investigation transfusion complications.
An investigation will only be initiated if the treating physician is aware of this possibility in a susceptible patient with a clinical picture suggestive of Transfusion-Associated Graft vs. Host Disease (TA-GVHD).
The investigation begins with the confirmation of the presence of GVHD. This is a pathologic diagnosis requiring a skin or intestinal biopsy. If GVHD is present, further studies should be performed to confirm the engraftment of donor lymphocytes.
Documenting and reporting complications of blood transfusion involve many aspects and interrelationships. Policies and procedures will vary from site to site. Where applicable, please find examples of the types of reporting that are required.
Physicians and nurses attending to patients who experience suspected transfusion complications should perform the following documentation and reporting functions:
Note: Canadian Blood Services offers no endorsement of and assumes no liability for the currency, accuracy, or availability of any information on these sites.
Note: Documentation must be maintained for all transfusions, whether or not complications occur.
The transfusion service is responsible for several aspects of documenting and reporting transfusion reactions and complications. These include documenting and reporting:
The types of reactions that should be reported are provided in the Standards for Blood Safety and below (under Canadian Blood Services).
Canadian Blood Services, the blood supplier in all Canadian provinces and territories except Quebec, receives reports of serious adverse reactions from transfusion services and reports them to Health Canada.
IMPORTANT: In Canadian Blood Services’ Circular of Information, review a detailed description about the reporting responsibilities and relationships between itself and transfusion services, including transfusion-transmissible diseases: Section A6. Reporting Serious Adverse Reactions.
Currently the only method of preventing transfusion-associated graft versus host disease (TA-GVHD) is to gamma irradiate cellular components at risk of causing TA-GVHD or destined for at risk recipients. Current techniques to leukoreduce cellular blood components are not adequate to prevent TA-GVHD
Canadian Blood Services produces the following gamma irradiated products:
Gamma irradiation, in the doses recommended for the prevention of TA-GVHD, does not affect the function of platelets. However, it does result in some damage to the erythrocyte membrane so that the permitted storage date of red cell concentrates is 28 days following irradiation (or the usual expiry date, whichever is shorter). There is also a more rapid accumulation of potassium in the extracellular fluid of the red cell concentrates. For this reason, for neonates and young children, it is preferable to gamma irradiate red cell components as close to the time of transfusion as possible. In these patients, if the units have not been irradiated just prior to transfusion, removal of extracellular fluid, (to reduce risks associated with high plasma potassium), may be considered.
Note: Canadian Blood Services offers no endorsement of and assumes no liability for the currency, accuracy, or availability of any information on these sites.