When to suspect this adverse reaction
Transfusion‑associated-graft-versus-host disease (TA-GVHD) is extremely rare and transfused patients present with fever, rash and diarrhoea commencing 1-2 weeks post-transfusion.
Laboratory findings include pancytopenia and liver function abnormalities.
TA-GVHD leads to profound marrow aplasia with a mortality rate >90%.
Death typically occurs within one to three weeks of first symptoms, most commonly due to overwhelming infections.
Usual causes
This normally happens to immunodeficient recipients whose immune system is unable to recognise transfused T lymphocytes as foreign.
These lymphocytes engraft in the recipient and react against the host.
The three primary risk factors for developing TA‑GVHD are:
- degree of immunodeficiency of the recipient.
- number of viable T lymphocytes transfused (affected by the age of the blood transfused, degree of leucodepletion and irradiation status), and
- genetic diversity between donor and recipient. Greatest risks are donations from blood relatives and with HLA-matched blood products.
Investigation
Diagnosis is normally made on skin biopsy and occasionally on liver or bone marrow biopsies.
In addition, the systematic recording of these cases may help in future risk assessments. Recording product factors known to influence viable T cell numbers may be of value.
What to do
Treatment is supportive and often, corticosteroids and cytotoxic agents are used, but are largely ineffective which means prevention is crucial.
For patients at risk, it’s critical to provide irradiated cellular blood components.
Leucocyte depletion reduces the risk of TA‑GVHD but is not recommended as an alternative to irradiation.
Cold storage of red cells
Red cells held in cold storage for 21 days or more may be considered irradiation equivalent.
If irradiation-equivalent red cells are not available, red cells in cold storage for 14 days or more may be considered TA-GVHD safe and used for patients at risk of TA‑GVHD.
Updated October 2026