Transfüzyon ilişkili GVHH

Yıl 2023, Cilt: 32 Sayı: 2, 91 - 96, 30.06.2023

Şendağ Yaslıkaya , Sedat Biter , Merve Koba , Merve Erdoğan , Naciye Nur Tozluklu , Bektaş Işık , Semra Paydaş

https://doi.org/10.17827/aktd.1182692

Öz

Transfüzyonun, kendisi hayat kurtaran bir tedavi olabildiği gibi, hayatı riske atabilecek komplikasyonlara da neden olduğu görüldü. Transfüzyon ilişkili graft versus host hastalığı (Ti-GVHH), kan transfüzyonları sonrasında nadir gelişen fatal bir komplikasyondur. Tİ-GVHH ilk olarak 1960’lı yıllarda ise Nispet ve Heskop tarafından, immun özelliğini koruyan lenfositlerin immun yetmezliği olan bireye verilmesi ile gelişen mortal bir hastalık olarak tanımlandı. Tİ-GVHH en sık eritrosit transfüzyonu ile ilintili bulunsa da, trombosit, granülosit ve donmamış plazma transfüzyonları ile gelişebilmektedir. Temel mekanizması, immun sistemin birincil işlevi olan kendinden ve kendinden olmayanı ayırt etme fonksiyonuna bağlı olarak gelişir. Bu riske eşlik edecek ya immunsuprese bir alıcı veya transfüze edilen kan ile parsiyel bir HLA benzerliğinin de olması gerekmektedir. Hem primer hem de sekonder immun yetmezlik durumları ile Tİ-GVHH geliştiği bilinmektedir. Parsiyel HLA benzerliği, transfüzyonda alıcı ile vericinin HLA genlerinin kismi benzerliğini ifade eder. En sık semptomları, cilt döküntüsü, ateş, hepatit, pansitopeni, diyare, kemik iliği hipoplazisi/aplazisidir. Tanısı güç olup, öncelikle şüphelenme ile başlamaktadır.Tanısı gibi tedavisi de zor bir hastalıktır. Bu yüzden replasman endikasyonunu doğru koymak gerekmektedir. Replasman yapılması planlanaması durumunda riskli hastalarda kan ürünü ışınlanması sağlanmalıdır.Diğer önleyici yöntemler,patojen inaktivasyonu, dondurma-çözdürme ve lökosit filtrasyonudur.Kesin tedavisi allojenik kemik iliği naklidir. Nakile uygun olmayan veya nakile kadarki zamanda immunsupresif ajanlarda kullanılabilemektedir

Anahtar Kelimeler

transfüzyon, nakil, akraba, hla

Kaynakça

• Referans1. Bordin JO, Heddle NM, Blajchman MA. Biological Effects of leukocytes present in transfused Cellular Blood Products. Blood 1994;84:1703-21
• Referans2. Simonsen M.The impact on the developing embryo and newborn animal of adult homologous cells. Acta Pathol Microbiol Scand 1957; 40:480–500.
• Referans3. Murphy JB: The effect of adult chicken organ graft on the chick embryo. J Exp Med 1916; 24:1–6.
• Referans4. Higgins MJ, Blackall DP. Transfusion-associated graft-versus-host disease: a serious residual risk of blood transfusion. Curr Hematol Rep 2005;4:470-6.
• Referans5. Appleton AL, Sviland L, Pearson AD, Wilkes J, Green MA, Malcolm AJ.Diagnostic features oftransfusion associated graft versus host disease. J Clin Pathol 1994;4:541-6.
• Referans6. Hathaway WE, Githens JH, Blackburn WR, Fulginiti V, Kempe CH: Aplastic anemia, histiocytosis and erythroderma in immunologically deficient children. N Engl J Med 1965; 273:953–8.
• Referans7. Naiman JL, Punnett H, Lischner HW, Destiné ML, Arey JB: Possible graft-versus-host reaction after intrauterine transfusion for Rh erythroblastosis fetalis. N Engl J Med 1969; 281:697–701
• Referans8. Shimoda, T. Postoperative erythrodermia. Geka (Surgery) 1955; 17: 487–92.
• Referans9. Vigorito AC, Campregher PV, Storer BE, Carpenter AP, Moravac C, Kiem HP et al. Evaluation of NIH consensus criteria for classification of late acute and chronic GVHD. Blood 2009; 114:702.
• Referans10. Zeiser R, Blazar BR. Acute Graft-versus-Host Disease - Biologic Process, Prevention, and Therapy. N Engl J Med 2017; 377:2167.
• Referans11. Kopolovic I, Ostro J, Tsubota H, Lin Y, Cserti-Gazdewich CM, Messner HA, et al. A systematic review of transfusion-associated graft-versus-host disease. Blood 2015; 126: 406–14.
• Referans12. Hathaway WE, Githens JH, Blackburn WR, Fulginiti V, Kempe CH. Aplastic anemia, histiocytosis and erythrodermia in immunologically deficient children. Probable human runt disease. N Engl J Med 1965; 273:953.
• Referans13. Brubaker DB. Human posttransfusion graft-versus-host disease. Vox Sang 1983; 45:401.
• Referans14. Maung ZT, Wood AC, Jackson GH, Turner GE, Appelton AL, Hamilton PJ. Transfusion-associated graft-versus-host disease in fludarabine-treated B-chronic lymphocytic leukaemia. Br J Haematol 1994; 88:649.
• Referans15. Leitman SF, Tisdale JF, Bolan CD, Popovsky MA, Klippel JH, Balow JE et al. Transfusion-associated GVHD after fludarabine therapy in a patient with systemic lupus Erythematosus. Transfusion 2003; 43:1667.
• Referans16. Postmus PE, Mulder NH, Elema JD. Graft versus host disease after transfusions of non-irradiated blood cells in patients having received autologous bone marrow. A report of 4 cases following ablative chemotherapy for solid tumors. Eur J Cancer Clin Oncol 1988; 24:889.
• Referans17. Schroeder ML. Transfusion-associated graft-versus-host disease. Br J Haematol 2002; 117:275.
• Referans18. Ohto H, Anderson KC. Survey of transfusion-associated graft-versushost disease in immunocompetent recipients. Transfus Med Rev 1996;10: 31 – 43.
• Referans19. Kleinman S, Stassinopoulos A. Transfusion-associated graft-versus-host disease reexamined: potential for improved prevention using a universally applied intervention. Transfusion 2018; 58:2545.
• Referans20. Drobyski W, Thibodeau S, Truitt RL, Baxter-Love LA, Gorski J, Jenkins R, et al. Third-party-mediated graft rejection and graft-versus-host disease after T-cell-depleted bone marrow transplantation, as demonstrated by hypervariable DNA probes and HLA-DR polymorphism. Blood 1989; 74: 2285.
• Referans21. De Dobbeleer GD, Ledoux-Corbusier MH, Achten GA. Graft versus host reaction. An ultrastructural study. Arch Dermatol 1975; 111:1597.
• Referans22. Matsukuma KE, Wei D, Sun K, Ramsamooj R, Chen M. Diagnosis and differential diagnosis of hepatic graft versus host disease (GVHD). J Gastrointest Oncol. 2016;7:21-31.
• Referans23. https://www.cdc.gov/nhsn/pdfs/biovigilance/bv-hv-protocol-current.pdf (Accessed on December 08, 2021.
• Referans24. Sharifi S, Dzik WH, Sadrzadeh SM. Human plasma and tirilazad mesylate protect stored human erythrocytes against the oxidative damage of gamma-irradiation. Transfus Med 2000;10:125-30.
• Referans25. Agbaht K, Altintas ND, Topeli A, Gokoz O, Ozcebe O. Transfusion-associated graft-versus-host disease in immunocompetent patients: case series and review of the literature. Transfusion 2007; 47: 1405.
• Referans26. Ní Loingsigh S, Flegel WA, Hendrickson JE, Tormey CA. Preventing transfusion-associated graft-versus-host disease with blood component irradiation: indispensable guidance for a deadly disorder. Br J Haematol 2020; 191:653.
• Referans27. Li M, Irsch J, Corash L, Benjamin RJ. Is pathogen reduction an acceptable alternative to irradiation for risk mitigation of transfusion-associated graft versus host disease?. Transfus Apher Sci. 2022;61:103404.
• Referans28. Cid J. Prevention of transfusion-associated graft-versus-host disease with pathogen-reduced platelets with amotosalen and ultraviolet A light: a review. Vox Sang. 2017;112:607-13.
• Referans29. Fast LD, DiLeone G, Marschner S. Inactivation of human white blood cells in platelet products after pathogen reduction technology treatment in comparison to gamma irradiation. Transfusion 2011; 51:1397.
• Referans30. Grass JA, Wafa T, Reames A, Gawes D, Corash L, Ferrara JL et al. Prevention of transfusion-associated graft-versus-host disease by photochemical treatment. Blood 1999; 93:3140.
• Referans31. Williamson LM, Stainsby D, Jones H, Love E, Chapman CE, Navarrete C, et al. The impact of universal leukodepletion of the blood supply on hemovigilance reports of posttransfusion purpura and transfusion-associated graft-versus-host disease. Transfusion 2007; 47:1455.
• Referans32. Akahoshi M, Takanashi M, Masuda M, et al. A case of transfusion-associated graft-versus-host disease not prevented by white cell-reduction filters. Transfusion 1992; 32:169.
• Referans33. Hayashi H, Nishiuchi T, Tamura H, Takeda K. Transfusion-associated graft-versus-host disease caused by leukocyte-filtered stored blood. Anesthesiology 1993; 79:1419.
• Referans34. Hutchinson K, Kopko PM, Muto KN, Tuscano J, O’Donnell RT, Holland PV,et al. Early diagnosis and successful treatment of a patient with transfusion-associated GVHD with autologous peripheral blood progenitor cell transplantation. Transfusion 2002; 42:1567.
• Referans35. Ferrara JL, Deeg HJ. Graft-versus-host disease. N Engl J Med 1991; 324:667.
• Referans36. Woods WG, Lubin BH. Fatal graft versus host disease following a blood transfusion in a child with neuroblastoma. Pediatrics 1981; 67:217.
• Referans37. Rosen RC, Huestis DW, Corrigan JJ Jr. Acute leukemia and granulocyte transfusion: Fatal graft-versus-host reaction following transfusion of cells obtained from normal donors. J Pediatr 1978; 93:268.
• Referans38. Betzhold J, Hong R. Fatal graft-versus-host disease after a small leukocyte transfusion in a patient with lymphoma and varicella. Pediatrics 1978; 62:63.
• Referans39. Ryo R, Saigo K, Hashimoto M, Kohsaki M, Yasufuku M, Watanabe N, et al. Treatment of post-transfusion graft-versus-host disease with nafmostat mesilate, a serine protease inhibitor. Vox Sang 1999; 76:241.
• Referans40. Dwyre DM, Holland PV. Transfusion-associated graft-versus-host disease. Vox Sang 2008; 95:85.
• Referans41. Oto OA, Paydas S, Baslamisli F, Tuncer İ, Ergin M, Kalakoç E, et al. Transfusion associated graft versus host disease. Eur J Intern Med. 2006;17(3):151-6.