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September 1988

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

Author Affiliations

From the Departments of Medicine (Drs Arsura, Bertelle, and Grob), Pathology (Dr Minkowitz), and Surgery (Dr Cunningham), Maimonides Medical Center, Brooklyn, NY.

Arch Intern Med. 1988;148(9):1941-1944. doi:10.1001/archinte.1988.00380090039010

• 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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