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TA-GvHDTransfusion-associated graft versus host disease (blood transfusions)
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TA-GVHD is almost always fatal, with a less than 10% survival rate.
Of these latter cellular products, components selected for their HLA compatibility by either typing or crossmatch (eg, red blood cells from first- and second-degree relatives and crossmatched, HLA-matched, and HLA-selected platelets) always require irradiation because of HLA homogeneity and a very high risk of TA-GVHD. (9,25,28) General considerations for product irradiation are discussed further below.
For nonrelated donor blood product transfusions, the predicted incidence of TA-GVHD is dependent on the population HLA haplotype frequencies and recipient immunosuppression.
One major risk for the development of TA-GVHD is lymphoproliferative malignancy, with Hodgkin lymphoma occupying a particular concern.
To date, there have not been any confirmed cases of TA-GVHD after transfusion of fresh frozen plasma, cryoprecipitate, any fractioned plasma products, or frozen deglycerolized cells, so these components do not require irradiation for the prevention of TAGVHD.
(38) It should be noted that there have not been any reported cases of TA-GVHD in humoral immunodeficiency syndromes or in conditions with primary neutrophil dysfunction, so these patients do not require irradiated blood products.
Of note, the BCSH Blood Transfusion Task Force takes the stance that " [i]t is not necessary to irradiate red cells for routine 'top-up' transfusions of premature or term infants." (10) The BCSH cited the fact that there are few reports of TA-GVHD in preterm and full-term infants (10); however, this does not appear to take into account the potential for developing TA-GVHD if a condition that would put the infant at risk has yet to be diagnosed.
Based on multiple documented cases of TA-GVHD in this population, the European School of Haematology, the European Group for Blood and Marrow Transplantation, the Foundation for the Accreditation of Cellular Therapy, and the BCSH Blood Transfusion Task Force all recommend irradiated blood products for allogeneic and autologous hematopoietic progenitor cell recipients.
Regarding non-Hodgkin lymphoma, the 2011 BCSH Blood Transfusion Task Force states, "There are relatively few reports of TA-GVHD in non-Hodgkin lymphoma (NHL) and the majority have been in patients with high-grade disease." (10) No further recommendation was specified for this group.
Granulocyte transfusions, which are given to neutropenic patients within 24 hours of collection and contain lymphocytes and have been identified as a potential cause of TA-GVHD, were only irradiated per policy in 995 of 2066 organizations (48.2%).
The BCSH Blood Transfusion Task Force recommends, "All granulocyte components should be irradiated before issue and transfused with minimum delay." (10) Other therapies not included in the AABB survey that have also been identified as potential causes of TA-GVHD are treatment with purine analogue drugs (fludarabine, cladribine, and deoxycoformycin) as well as alemtuzumab (an anti-CD52 agent) and ATG.
Curiously, the converse was true for patients with solid organ tumors, where the percentage of those providing irradiated cellular blood product for the prevention of TA-GVHD nearly doubled, from 95 of 474 (20.0%) in 1989 to 818 of 2076 (39.4%) in 2014.