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Two cases of postoperative erythroderma
The Keio Journal of Medicine
|June 1, 1989
Summary
Postoperative erythroderma, a fatal condition after surgery, may be a graft-versus-host reaction from transfused blood. This immune response might be triggered by cardiopulmonary bypass and massive transfusions, particularly in genetically similar populations.
Area of Science:
- Immunology
- Hematology
- Transfusion Medicine
Background:
- Postoperative erythroderma is a rare, often fatal disease following surgery, particularly cardiovascular procedures.
- Characterized by fever, rash, hepatic dysfunction, and leukopenia, its etiology remains unclear.
- Previous cases suggest a link to extensive blood transfusions.
Observation:
- Two cases of postoperative erythroderma were observed, with one showing genetic HLA mismatch between the patient and family.
- This mismatch strongly suggests a graft-versus-host (GVH) reaction mediated by transfused lymphocytes.
- The underlying immune suppression predisposing patients to GVH is unknown but cardiopulmonary bypass and fresh blood transfusion are suspected.
Findings:
- Postoperative erythroderma is proposed to be a form of graft-versus-host (GVH) disease.
- Transfused lymphocytes in patients with suppressed immunity may trigger this reaction.
- Genetic factors and transfusion practices, especially in homogeneous populations like Japan, warrant further investigation.
Implications:
- Understanding the GVH mechanism in postoperative erythroderma could lead to improved diagnostic and therapeutic strategies.
- This finding highlights the potential risks associated with massive blood transfusions and immunosuppression.
- Further research is needed to elucidate the exact causes of immune suppression and the racial predilection observed in Japanese patients.