Diagnosis of transfusion-associated graft-versus-host disease by genetic fingerprinting and polymerase chain reaction

Can post-mortem blood be used for DNA profiling after peri-mortem blood transfusion?

The question of whether blood transfusions can affect DNA profiling is still a contentious issue throughout the forensic community. It is hypothesised that donor leucocytes present in the administered blood will be detected upon examination of recipient blood. In order to resolve this issue, a selection of theoretical experiments were carried out to determine how much donor DNA must be present for its detection in blood components. Five casework examples of material collected from individuals after massive transfusion, including a case of whole organ transplantation, were also investigated. The results indicated that filtration processes used during blood production do not allow the passage of enough donor leucocytes for detection using current forensic profiling techniques. No evidence of secondary profile alleles were found in any case, indicating that peri-mortem blood transfusion does not affect DNA profiling.

Prevention of transfusion-associated graft-versus-host disease by inactivation of T cells in platelet components

Patients with hematological malignancies and infants with congenital immunodeficiencies who received blood are two of many populations at risk for transfusion-associated graft-versus-host disease (TA-GVHD). Of the methodologies (eg, photoinactivation, peglyation, ultraviolet light, and irradiation) that can be used to prevent TA-GVHD, only irradiation of whole blood and cellular components is currently accepted practice of the US Food and Drug Administration (FDA). Among the newer methods that have been developed to reduce the risks of bacterial and viral contaminants of platelet transfusions, photochemical treatment (PCT) using psoralens and long-wavelength ultraviolet (UVA) irradiation modifies bacterial and viral genomes sufficiently to inhibit replication. Among a broad group of compounds, the synthetic psoralen compound amotosalen hydrochloride (HCl) (S-59) has been shown to be particularly effective in inactivating bacteria and viruses, without adversely affecting in vitro and in vivo platelet function.

In vitro and in vivo measurements of gamma-radiated, frozen, glycerolized RBCs

BACKGROUND

Transfusion-associated GVHD results from the presence of viable lymphocytes in transfused allogeneic blood components. Viable immunocompetent lymphocytes have been detected in RBCs that were frozen with glycerol and washed before transfusion.

STUDY DESIGN AND METHODS

The study reported here assessed the effect of irradiation on human RBCs frozen with 40-percent (wt/vol) glycerol and stored at -80 degrees C. In vitro and in vivo testing was done on human RBCs that were frozen with 40-percent (wt/vol) glycerol at -80 degrees C, with some units exposed to 2500 cGy of gamma radiation and others not irradiated, and that, after thawing and washing, were stored in a sodium chloride-glucose solution at 4 degrees C for 3 days before autologous transfusion.

RESULTS

The glycerol-frozen RBCs treated with 2500 cGy before deglycerolization had a mean freeze-thaw-wash recovery of 87 percent and a mean 24-hour posttransfusion survival of 86 percent after storage for 3 days at 4 degrees C in a 0.9-percent NaCl and 0.2-percent glucose solution. For the nonirradiated units, the mean freeze-thaw-wash recovery was 85 percent and the mean 24-hour posttransfusion survival was 83 percent.

CONCLUSION

These data show similar, acceptable results for RBCs frozen with 40-percent (wt/vol) glycerol at -80 degrees C and treated in the frozen state with 2500 cGy of gamma radiation and for RBCs that were not irradiated, all of which were washed and then stored in a sodium chloride-glucose solution for 3 days before autologous transfusion.

Transfusion-associated graft-versus-host disease and its prevention

Transfusion-associated graft-versus-host disease is a rare but usually fatal complication of transfusion of cellular blood components, caused by multiorgan engraftment and proliferation of donor T lymphocytes. The classical features of skin rash, diarrhoea and hepatitis, along with striking bone-marrow failure, are seen 1-2 weeks after transfusion. Although early reports described the condition only in immunosuppressed individuals, sharing of an HLA haplotype between donor and an immunocompetent recipient can also result in transfusion-associated graft-versus-host disease. The condition is entirely preventable by gamma irradiation of cellular blood components to 25 Gy, although this results in some reduction of red-cell viability and increased loss of red-cell potassium. The major indications for irradiated blood components include bone marrow/stem cell auto- or allografting, Hodgkin's disease, intrauterine transfusions, and transfusions from relatives or HLA-selected platelet donors.

Diagnosis of transfusion-associated graft-versus-host disease by polymerase chain reaction in fludarabine-treated B-chronic lymphocytic leukaemia

Transfusion-associated graft-versus-host disease (TA-GVHD), has rarely been reported associated with B-chronic lymphocytic leukaemia (B-CLL). We report a patient diagnosed with B-CLL, previously treated with fludarabine, who developed TA-GVHD after being transfused during surgery for splenectomy. Diagnosis was confirmed by polymerase chain reaction (PCR) detection of donor DNA in the patient, by amplification of Y-chromosome sequence and analysis of minisatellite polymorphisms. B-CLL patients treated with fludarabine appear to be at risk for TA-GVHD and should be regarded as candidates for transfusions with irradiated blood products. This case illustrates that PCR is a rapid technique for the early diagnosis of TA-GVHD.

Transfusion-associated graft-versus-host disease: current concepts and future trends

Since the initial reports, in the early 1960s, of Transfusion-Associated Graft-versus-Host Disease (TA-GVHD) in infants with congenital immunodeficiency and individuals with various haematological malignancies, our knowledge of this rare but uniformly fatal consequence of transfusion has improved. Today, it is possible to define with greater certainty patients who are most at risk; the blood components capable of causing TA-GVHD; and the methods for preventing TA-GVHD. In the absence of effective treatment for TA-GVHD, attention is currently focused on potential preventative measures, in particular using u.v.- or gamma-irradiated blood components. This overview deals with some general aspects of the current concepts and future trends in treatment of TA-GVHD.

HLA homozygosity and shared HLA haplotypes in the development of transfusion-associated graft-versus-host disease

We review the pathogenesis, epidemiology and patient cases of transfusion-associated graft-versus-host disease (TA-GVHD) in the context of host inability to eliminate viable donor T-lymphocytes. This review is based on the published English-language literature pertaining to TA-GVHD, including case reports with HLA data on transfusion recipients as well as blood donors. The role of shared histocompatibility antigens between the donor and the recipient in promoting TA-GVHD is discussed critically. Since TA-GVHD is usually a fatal disease for which effective therapy is lacking, prevention is of utmost importance and guidelines for gamma-irradiation of cellular blood products are presented. TA-GVHD has been described in immunodeficient as well as in immunocompetent hosts, and following blood product transfusions from related as well as from unrelated donors. This review includes analysis of patient data in each of these settings and probability estimates based on principles of population genetics. We emphasize that transfusion of blood products from individuals who are homozygous at the HLA loci to heterozygous recipients who share that HLA haplotype occurs at a frequency proportional to the genetic homogeneity of the population and that the process mediating TA-GVHD in such instances appears to be independent of the host's immune status.

On the potential of simple repetitive DNA for fingerprinting in clinical, forensic, and evolutionary dynamic studies

The purpose of this review is to discuss critically the practical meaning of a specific genome component, simple repetitive desoxyribonucleic acid (DNA) sequences as clinical and forensic and diagnostic and research tools. Previously, multilocus DNA fingerprinting was the major technology employed to visualize such simple repeat sequences. This technique enables many polymorphic loci to be simultaneously detected thus yielding vast amounts of information. With the advent of enzymatic DNA amplification via the polymerase chain reaction (PCR), individual simple repeat loci can be demonstrated, theoretically even from single DNA molecules and so a wealth of additional approaches have also become feasible. In general investigating, small, known, single copy parts of genomes have not posed truly insurmountable problems if enough material was available. There have even been a few (anecdotal) reports on the amplification of simple repeats from ancient DNA (see, e.g. [30]. Here we would like to after a solid basis for an earnest discussion of the applications of these simple repetitive sequences using various methodological approaches relevant for clinical diagnosis, setting aside the obvious unsolved mysteries of their biology.

Diagnostic applications of repetitive DNA sequences

The potential, the advantages and the different areas of diagnostic applications are discussed for the various categories of repetitive DNA sequences. Since all eukaryotes are characterized by genomic redundancy, these sensitive, rapid and comparatively simple techniques are revolutionizing many a field of clinical and experimental diagnostics.