Transfusion-associated graft-versus-host-disease: case report and review of literature

Transfusion-associated graft-versus-host disease (GVHD) is a rare condition that can occur after receipt of any cellular blood component with viable lymphocytes. Pathogenesis depends on immunocompetent donor T lymphocytes and a host immune system unable to clear donor cells before they proliferate, engraft, and attack host cells. Unlike bone marrow transplantation-associated GVHD, transfusion-associated disease destroys marrow stem cells early in the course of the disease, resulting in pancytopenia contributing to a fulminant clinical course and nearly 100% mortality. Transfusion-associated disease may be diagnosed late or completely missed; thus, true incidence rates are uncertain. We report our experience with an oncology patient who developed transfusion-associated GVHD. This report also reviews the literature to discuss established GVHD risk factors as well as provide recommendations for standardized reporting to better understand incidence rates and possible risk factors. This information would allow individual physicians and blood bank associations to make more informed decisions on the use of irradiated blood products.