Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare problem that can happen after a blood transfusion. It usually appears between two and 30 days after the transfusion. Most people who get it become very sick, and in most cases, it leads to death. A blood transfusion is a procedure where one person receives donated blood products directly into their bloodstream (intravenously).

People who have had a stem cell transplant have an increased risk of developing this complication after a blood transfusion.

In this article, we’ll review what TA-GVHD is, who is at risk, and how to treat it.

What Causes TA-GVHD?

In GVHD, the graft (the donated blood products) rejects the host (the person who receives the blood). One specific type of lymphocyte (immune cell) from the donor, called a T cell, is responsible for causing GVHD. Normally, T cells find and kill foreign invaders, like germs and cancer cells. Before attacking and killing a cell, T cells check the proteins on the surface of the cell, called human leukocyte antigens (HLAs). If the pattern of HLA proteins matches what the T cell knows to be part of the body, it won’t attack. However, if the HLA proteins don’t match, the T cell thinks the cell is a foreign invader and will attack.

The way TA-GVHD develops is similar to how GVHD develops after a stem cell transplant. After a stem cell transplant, T cells in the donor sample of stem cells can begin to attack healthy cells in the recipient.

TA-GVHD can happen if there are active T cells present in the blood products used for a blood transfusion. T cells can be found in most types of blood products, including:

• Whole blood
• Red blood cells (RBCs)
• Platelets
• Plasma that hasn’t been frozen

Normally, the recipient’s immune system destroys any T cells before they can start to attack. However, if the recipient’s immune system doesn’t destroy the T cells in the donor blood, the T cells may begin to grow and divide in the recipient. Eventually, the T cells can begin to attack healthy cells in the recipient.

Who Is at Risk of TA-GVHD?

There are three main risk factors for TA-GVHD:

• Receiving a blood transfusion from a donor who is a partial HLA match, such as a family member
• Having a weakened immune system, which reduces the body’s ability to eliminate donor T cells
• Receiving blood products that contain a high number of T cells, which increases the risk of donor immune cells attacking the recipient

These risk factors could make it harder for the recipient’s immune system to recognize and destroy T cells in the donated blood products before they attack.

Family members are more likely to have a close or partial HLA match. That means that the recipient’s immune system may not recognize the donor T cells as foreign, and they may attack.

People with a weakened immune system may also have difficulty recognizing and attacking donor T cells. Someone may have a weakened immune system if they are taking immunosuppressant medications, have cancer, or have had a stem cell transplant.

In some cases, TA-GVHD develops in people without any risk factors (something that makes a disease more likely). More research is needed to learn more about why TA-GVHD occurs. However, research is difficult since this condition is so rare.

How Is TA-GVHD Prevented?

Have you wondered if this can be prevented? To lower the risk of TA-GVHD, healthcare providers can use irradiated blood. Irradiation of blood involves putting the donated blood products into a machine that uses gamma irradiation or X-rays to prevent T cells from launching an attack against the recipient.

Many hospitals will use irradiated blood components only for people at risk, such as newborns and people with compromised immune systems.

If you’ve had a stem cell transplant, it’s a good idea to talk to your healthcare team to find out if you might need irradiated blood if you ever need a blood transfusion in the future.

How Common Is TA-GVHD?

TA-GVHD occurs very rarely. Studies report that TA-GVHD occurs in 0.2 percent to 5 percent of people who get a blood transfusion. Since many hospitals started using irradiated blood, the incidence of TA-GVHD has dropped significantly. Between 2005 and 2013, there were three reported deaths in the United States from TA-GVHD.

What Are the Symptoms of TA-GVHD?

If TA-GVHD develops, symptoms usually start five to 10 days after a blood transfusion. However, TA-GVHD symptoms have been reported in as little as three days and up to 30 days after a blood transfusion. The most common symptom is fever.

In TA-GVHD, donor T cells most commonly attack certain tissues, including:

• The skin
• The gastrointestinal (digestive) system
• The liver
• The bone marrow

If TA-GVHD affects the skin, it may cause a rash with areas of raised and flat skin that’s discolored and irritated. The rash often involves many parts of the body, including the face, chest, back, arms, and legs.

If TA-GVHD affects the digestive tract, it can cause symptoms such as:

• Diarrhea, which may contain blood
• Stomach pain
• Nausea
• Vomiting

TA-GVHD that affects the liver can result in the following signs and symptoms:

• Jaundice (yellowing of the skin and whites of the eyes)
• Enlarged liver
• Elevated liver enzymes found in a blood test

If TA-GVHD affects the bone marrow, it can cause bone marrow failure. In bone marrow failure, the bone marrow doesn’t make enough red blood cells, white blood cells, and platelets. This is also known as pancytopenia. People with pancytopenia are more likely to develop infections and abnormal bleeding.

In some cases, people with TA-GVHD may develop shortness of breath and seizures.

How Is TA-GVHD Diagnosed?

It can be difficult to diagnose TA-GVHD because the symptoms can be caused by other conditions. However, healthcare providers may suspect TA-GVHD in people who have recently had a blood transfusion who have a rash, diarrhea, and fever.

Healthcare providers may order blood tests to check for liver problems and bone marrow failure. Some blood tests can also check for the presence of donor T cells.

To be sure of the diagnosis, healthcare providers may take a biopsy (a tissue sample to examine under a microscope). The tissue sample is taken from an affected organ. If the skin is affected, a skin biopsy is usually the easiest.

How Is TA-GVHD Treated?

Suppressing the immune response with immunosuppressants is the main treatment for TA-GVHD. Just like with GVHD, corticosteroids, such as prednisone, are considered the preferred treatment. Depending on the response to corticosteroids and symptom severity, other immunosuppressant drugs may be used, such as:

• Antithymocyte globulin (Thymoglobulin)
• Cyclosporine (Gengraf, Neoral, Sandimmune)
• Tacrolimus (Astagraf, Envarsus, Prograf)

The most effective treatment for TA-GVHD is a stem cell transplant. To be effective, this treatment must be performed quickly. However, in people who don’t have a closely matched donor, it can be difficult to find a donor in time.

What’s the Outlook for People With TA-GVHD?

If TA-GVHD develops after a blood transfusion, the prognosis (outlook) is poor. Several studies have found that more than 90 percent of people with TA-GVHD will die from the disease. Most people will die within three weeks of their first symptoms. The most common cause of death is infection due to pancytopenia.

Talk With Others Who Understand

On myGVHDteam, people with GVHD and their loved ones come together to better understand life with GVHD.

Are you or a loved one living with TA-GVHD? What questions do you have about TA-GVHD? Share your experience in the comments below.