Intact survival with transfusion-associated graft-versus-host disease proved by human leukocyte antigen typing of lymphocytes in skin biopsy specimens☆,☆☆,★
Section snippets
CASE REPORT
After 30 weeks of gestation a female premature infant was delivered by cesarean section to healthy parents. The mother was Rh negative and the father was Rh positive. It was the mother's fifth pregnancy; the first had no complications, and anti-D prophylaxis was not administered. The second child and the third child had hemolytic disease of the newborn and required postnatal transfusions or exchange transfusion. A fourth pregnancy ended in abortion. During the fifth pregnancy the mother's
Immunohistologic studies of frozen sections
We used a two-step immunoperoxidase technique to incubate monoclonal antibodies against supertypic HLA epitopes (class I and class II), Langerhans cells (CD1), T lymphocytes (CD3, CD4, CD8, and CD25), and against subtypic HLA-A and B-alleles8, 9 on acetone-fixed sections of fresh-frozen skin. We found a complete absence of CD1+ dendritic cells, a homogeneous HLA-DR expression of epidermal keratinocytes, and predominance of CD8 + T cells in the epidermotropic infiltrate. Anti-HLA-A1 antibody
DISCUSSION
In addition to marked eosinophilia, the leading clinical criterion for the diagnosis of GVHD in this infant was the skin manifestation.2, 5, 6 However, toxic drug reactions, viral infections (especially cytomegalovirus), and septicemia may produce similar rashes.6 Even histologic and routine immunohistologic examination of a skin biopsy specimen, though quite typical, is not specific for TGVHD; similar alterations can be found in toxic drug reactions and after chemotherapy or radiation
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Cited by (12)
History of graft-versus-host disease
2016, Experimental HematologyCitation Excerpt :Why would delayed and chronic GvHD occur only after allogeneic BMT and not after HLA-mismatched blood transfusions? In 1995, two different reports indicated TaGvHD in human patients can be chronic and is not always lethal [64,65]. In 1965, English heart surgeons noticed early postoperative jaundice in 13% of their patients.
Transfusion-Associated Graft-Versus-Host Disease
2009, Transfusion Medicine ReviewsCitation Excerpt :In the setting of intrauterine and subsequent exchange transfusions, relatively large volumes of blood are transfused to patients with a relatively immature immune system, placing them at increased risk to develop TA-GvHD. A number of cases have been reported after exchange transfusions in newborns with erythroblastosis fetalis who had been given an intrauterine transfusion previously.36-39 Transfusion-associated GvHD after exchange transfusions has also been reported in newborns who did not receive intrauterine transfusions before exchange transfusions.40-42
Blood, blood components, plasma, and plasma products
1997, Side Effects of Drugs AnnualModerate and transient transfusion-associated cutaneous graft-versus- host disease in a child infected by human immunodeficiency virus
1996, American Journal of MedicineNeonatal erythroderma
2010, Current Opinion in Pediatrics
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From the Departments of Pediatrics, Dermatology, and Obstetrics and Gynecology, University Hospital, Münster, Germany; the Department of Dermatology, University Hospital, Würzburg, Germany; the Department of Pediatrics, University Hospital, Ulm, Germany; and the Institute of Immunology, University of Kiel, Kiel, Germany.
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Reprint requests: R. Hentschel, MD, Department of Pediatrics, University of Münster, Albert-Schweitzer-Str. 33, 48129 Münster, Germany.
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