SHOT Annual Report 2009 - Serious Hazards of Transfusion

17. Transfusion-Associated Graft-versus-Host Disease (TA-GvHD)
Definition
Transfusion-associated graft-versus-host disease is a generally fatal immunological complication of transfusion
practice, involving the engraftment and clonal expansion of viable donor lymphocytes contained in blood
components in a susceptible host. TA-GvHD is characterised by fever, rash, liver dysfunction, diarrhoea,
pancytopenia and bone marrow hypoplasia occurring less than 30 days following transfusion. The diagnosis
is usually supported by skin/bone marrow biopsy appearance and/or the identification of donor-derived cells,
chromosomes or deoxyribose nucleic acid (DNA) in the patient’s blood and/or affected tissues.
No new case of TA-GvHD was reported in 2009.
Figure 20
Number of cases of TA-GvHD reported to SHOT each year
5
4
Number of cases
3
2
1
0
1996–97
1997–98
1998–99
1999–00
2000–01
2001–02
(15 months)
2003
2004
2005
2006
2007 2008 2009
Year of report
COMMENTARY
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No report of TA-GvHD has been received during the last 8 years.
A total of 13 cases of TA-GvHD have been reported to SHOT since 1996, all of which were fatal.
Two cases have followed transfusion of leucodepleted components. One case occurred before the introduction
of leucodepletion of all cellular components (except granulocytes/buffy coats), which took place in late
1999. This followed transfusion of a leucodepleted component to a patient and was reported in 1998–99.
Another case occurred since the introduction of universal leucodepletion which was reported in 2000–2001.
This year SHOT received reports of 91 patients with a requirement to receive irradiated blood in accordance
with BCSH guidelines 20 who received non-irradiated components in error. Of these, 69 were attributed to
clinical errors and 22 to laboratory errors: fortunately none developed TA-GvHD. In the last 7 years a total of
596 such cases have been reported, none of whom developed TA-GvHD.
128 17. Transfusion-Associated Graft-versus-Host Disease (TA-GvHD)