6
#14
TRANSFUSION ASSOCIATED GRAFT VS. HOST DISEASE IN AN IMMUNOCOMPETENT RECIPIENT CASE REPORT.
G. Kross ¹, D. Zern ¹, M. Snyder ¹, C. Helinski ¹, G. Pillage ¹, J. Martell ¹, A. Girnita ¹, D. Triulzi ², R. Duquesnoy ¹ and A. Zeevi ¹. ¹ Pathology, UPMC, Pittsburgh, PA, USA and ² Blood Bank .

---

Transfusion associated graft vs. host disease (TAGVHD) can be a fatal complication of transfusion of non-irradiated cellular blood components to a susceptible recipient. Engrafted donor T cells damage host tissues including skin, liver, gastro-intestinal tract and bone marrow.
Methods. An 82-year-old previously healthy Caucasian man received 6 units of non-leukoreduced non-irradiated ADSOL red cells and a 6 unit pool of non-leukoreduced non-irradiated whole blood platelet concentrates during a coronary bypass grafting. Two weeks later and over a period of 14 days his condition worsened with symptoms of grade II GVHD on skin biopsy, leukopenia with WBC count of 0.1 to 0.3K and sepsis.
Results. Post mortem, HLA testing was performed on spleen cells. All 12 blood donors were also typed and one donor was found to be homozygous for a shared haplotype with the patient ( HLA -A1,- ;B8,- ;C7,-;BW6 ,-; DR17,-;DRw: 52,-;DQ2,- ). We were not able to show mixed chimerism in the splenic sample by STR. It is most likely that the level of donor cells in the spleen was below the threshold of our detection (<5%).
Conclusions. Immunocompromised patients and recipients of blood from HLA-matched donors can be at risk for TAGVHD. This is the first case of fatal TAGVHD reported in the US in an apparently immunocompetent patient who received a random unit of volunteer non-irradiated red cells from a donor who was homozygous for a shared HLA haplotype.