TRANSFUSION ASSOCIATED GRAFT VERSUS HOST DISEASE
AbstractTransfusion associated graft versus host disease (TA-GVHD) results from engraftment of viable donor T-lymphocytes in recipient that can not recognize or destroy them. It is seen in immunocompromised patients and pre-mature neonates. It can also occur in immunocompetent individuals receiving blood from first-degree relatives. It has emerged as single most common cause of death resulting from transfusion. Patients with B-cell malignancies appear to be especially at risk. TA-GVHD is associated with 80-90% mortality. Death most commonly occurs due to infection or haemorrhage secondary to pancytopenia. It is therefore important to prevent its occurrence. Prevention can be achieved either by complete removal of T-lymphocytes from donors blood or by abolishing their proliferating potentials. Available methods of leuko-depletion are not effective in preventing TA-GVHD. Only effective way is to inactivate T-lymhocytes. This can be achieved by irradiating blood product with gamma or X-ray irradiation. The concerns about malignant transformation of cells or reactivation of intracellular viruses have not been proved so far. Newer technologies for T-cell inactivation, which are not based on irradiation, are currently under trial.Key words: Transfusion hazards, TA-GVHD, Graft versus Host Disease, Blood product irradiation, Transfusion to immunocompromised, Transfusion from first degree relatives
Brubaker DB. Human post-transfusion graft versus host disease. Vox Sang 1983; 45:401-420
Thaler M, Shamiss A, Orgad S, Huszar M, Nussinivitch N, Meisel S, et al: The role of blood from HLA-homozygous donors in fatal transfusion-associated graft-versus-host disease after open-heart surgery. N Eng J Med 1989; 321:25-8.
British Blood Transfusion Society (2002). SHOT Annual Report 2000-2001.
Ohto H, Anderson KC. Survey of transfusion associated graft-versus-host disease in immunoco-mpetent recipients. Trans Med Rev 1996;10:31-43.
Ministry of Health, Pakistan (2003) National Blood Policy and Strategic Framework Document: Executive Summary.
Billingham R. The biology of graft-versus-host reactions. Harvey Lectures 1966-67; 62: 21-78.
Ferrara JL, Krenger W. Graft-versus-host disease: The influence of type 1 and type 2 T cell cytokines. Trans Med Rev 1998;12:1-17.
Kunstmann E, Bocker T, Roewer L, Sauer H, Mempel W, Epplen JT. Diagnosis of transfusion-associated graft-versus-host disease by genetic fingerprinting and polymerase chain reaction. Transfusion 1992;32:766-70.
Korngold R. Biology of graft-versus-host disease. American Journal of Paediatric Haematology Oncology 1993;15:18-37.
NBTS/NIBSC (1993) Guidelines for the Transfusion Service. HMSO, United Kingdom.
Gorlin J, Mintz P. Transfusion-associated graft-versus-host disease. In Mintz P (ed): Transfusion Therapy: Clinical Principles and Practice. Bethesda, Md, AABB Press, 1999; pp 341-57.
BCSH Blood Transfusion Task Force (Chairman D. Voak). Guidelines on gamma irradiation of blood components for the prevention of transfusion-associated graft-versus-host disease. Transfusion Medicine 1996; 6:261-71.
Fast LD, DiLeone G, Edson CM, Purmal A. PEN 110 treatment functionally inactivates the PBMNCs present in RBC units: Comparison to the effects of exposure to g irradiation. Transfusion 2002; 42: 1318-25.
Lazo A, Tassello J, Jayarama J, Ohagen A, Gibaja V, Kramer E et al. Broad-spectrum virus reduction in red cell concentrates using INACTINE PEN 110 chemistry. Vox Sang 2002; 83: 313-23.
Zavizion B, Serebryanik D, Serebryanik I, Chapman J, Purmal A. Prevention of Yersinia enterocolitica, Pseudomonas fluorescens, and Pseudomonas putida outgrowth in deliberately inoculated blood by a novel pathogen-reduction process. Transfusion 2003;43:135-42.