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Transfusion-Associated—Graft-vs-Host Disease in a Presumed Immunocompetent Patient

Edward L. Arsura, MD; Anthony Bertelle, MD; Stanley Minkowitz, MD; Joseph N. Cunningham Jr, MD; David Grob, MD
Arch Intern Med. 1988;148(9):1941-1944. doi:10.1001/archinte.1988.00380090039010.
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• Since the advent of bone marrow transplantation, a vexing clinical problem is that of acute graft-vs-host disease (GVHD). A less well-recognized disorder is that of GVHD in patients receiving blood products containing immunocompetent lymphocytes. Transfusion-associated (TA)—GVHD has a lower incidence and higher mortality (>90%) than bone marrow transplantation—GVHD and until now has been limited to patients with hereditary or acquired immunologic deficits and to patients immunocompromised by chemotherapy for malignant neoplasms. We presently describe a patient who underwent coronary artery bypass graft surgery and who suffered what we believe was TA-GVHD. This diagnosis is supported by considering the chronology of events (in particular, blood transfusion), clinical features (fever, rash, abnormal results of liver function tests, diarrhea, and pancytopenia), and a skin biopsy specimen that revealed basal cell vacuolation and lymphocyte satellitosis that are considered characteristic for this disorder. We believe TA-GVHD can occur in previously immunocompetent patients who receive transfusions of blood products containing functioning lymphocytes and that this awareness will lead to the discovery of additional cases and a better understanding of this disorder.

(Arch Intern Med 1988;148:1941-1948)


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