Transfusion medicine handbook

7. Adverse Effects of Transfusion

7.14 Transfusion-associated Graft-versus-host Disease

Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare complication of transfusion caused by engraftment and proliferation of transfused donor T-lymphocytes which destroy recipient cells carrying "foreign" human leucocyte antigens (HLA).  Immunodeficient patients such as allogeneic bone marrow transplant recipients receiving cellular components and fetuses receiving intrauterine transfusions are at special risk for this disease. TA-GVHD has also occurred in immunologically normal patients after transfusion of blood from a relative.

TA-GVHD is fatal in almost all cases. Acute TA-GVHD begins from 4 - 40 days after transfusion with high fever followed by a diffuse erythematous skin rash progressing to erythroderma and desquamation. Gastrointestinal and liver dysfunction occur and, unlike GVHD following stem cell transplants, pancytopenia is common.

TA-GVHD is prevented by gamma irradiation of cellular blood components (red cells and platelets) to a minimum dose of 25 Gray (Gy) targeted to the central position of the container and 15 Gy to all other parts of the container. The irradiation dose must not exceed 50 Gy.

For further information regarding irradiation of blood components see Section 4.6: Irradiation.