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INTERCEPT Pathogen Reduction in Platelet Concentrates, in Contrast to Gamma Irradiation, Induces the Formation of trans-Arachidonic Acids and Affects Eicosanoid Release during Storage. Biomolecules 2022; 12:biom12091258. [PMID: 36139096 PMCID: PMC9496540 DOI: 10.3390/biom12091258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/01/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022] Open
Abstract
Pathogen inactivation techniques for blood products have been implemented to optimize clinically safe blood components supply. The INTERCEPT system uses amotosalen together with ultraviolet light wavelength A (UVA) irradiation. Irradiation-induced inactivation of nucleic acids may actually be accompanied by modifications of chemically reactive polyunsaturated fatty acids known to be important mediators of platelet functions. Thus, here, we investigated eicosanoids and the related fatty acids released upon treatment and during storage of platelet concentrates for 7 days, complemented by the analysis of functional and metabolic consequences of these treatments. Metabolic and functional issues like glucose consumption, lactate formation, platelet aggregation, and clot firmness hardly differed between the two treatment groups. In contrast to gamma irradiation, here, we demonstrated that INTERCEPT treatment immediately caused new formation of trans-arachidonic acid isoforms, while 11-hydroxyeicosatetraenoic acid (11-HETE) and 15-HETE were increased and two hydroperoxyoctadecadienoic acid (HpODE) isoforms decreased. During further storage, these alterations remained stable, while the release of 12-lipoxygenase (12-LOX) products such as 12-HETE and 12-hydroxyeicosapentaenoic acid (12-HEPE) was further attenuated. In vitro synthesis of trans-arachidonic acid isoforms suggested that thiol radicals formed by UVA treatment may be responsible for the INTERCEPT-specific effects observed in platelet concentrates. It is reasonable to assume that UVA-induced molecules may have specific biological effects which need to be further investigated.
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Foukaneli T, Kerr P, Bolton‐Maggs PH, Cardigan R, Coles A, Gennery A, Jane D, Kumararatne D, Manson A, New HV, Torpey N. Guidelines on the use of irradiated blood components. Br J Haematol 2020; 191:704-724. [DOI: 10.1111/bjh.17015] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Theodora Foukaneli
- NHS Blood and Transplant Cambridge Cambridge UK
- Department of Haematology Cambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - Paul Kerr
- Department of Haematology Royal Devon & Exeter NHS Foundation Trust Exeter UK
| | - Paula H.B. Bolton‐Maggs
- Faculty of Biology, Medicine and Health University of Manchester Manchester UK
- Serious Hazards of Transfusion Office Manchester Blood Centre Manchester UK
| | - Rebecca Cardigan
- Haematology University of Cambridge Cambridge Biomedical Campus Cambridge UK
| | - Alasdair Coles
- Clinical Neuroscience University of Cambridge Cambridge Biomedical Campus Cambridge UK
| | - Andrew Gennery
- Department of Paediatric Immunology Institute of Cellular Medicine Newcastle University Cambridge Newcastle upon Tyne UK
| | - David Jane
- Department of Medicine University of Cambridge Cambridge Biomedical Campus Cambridge Cambridge UK
| | - Dinakantha Kumararatne
- Department of Clinical Immunology Cambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - Ania Manson
- Department of Clinical Immunology Cambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - Helen V. New
- NHS Blood and Transplant London UK
- Department of Haematology Imperial College London London UK
| | - Nicholas Torpey
- Department of Clinical Nephrology and Transplantation Cambridge University Hospitals NHS Foundation Trust Cambridge UK
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Yang H, Kim W, Bae J, Kim H, Kim S, Choi J, Park J, Jung DI, Koh H, Yu D. Effects of irradiation and leukoreduction on down-regulation of CXCL-8 and storage lesion in stored canine whole blood. J Vet Sci 2019; 20:72-78. [PMID: 30541183 PMCID: PMC6351766 DOI: 10.4142/jvs.2019.20.1.72] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 11/20/2022] Open
Abstract
White blood cells (WBCs) and storage period are the main factors of transfusion reactions. In the present study, cytokine/chemokine concentrations after leukoreduction (LR) and irradiation (IR) in stored canine whole blood were measured. Red blood cell storage lesion caused by IR and LR were also compared. Blood samples from 10 healthy Beagles were divided into four groups (no treatment, LR-, IR-, and LR + IR-treated). Leukocytes were removed by filtration in the LR group and gamma radiation (25 Gy) was applied in the IR group. Immunologic factors (WBCs, interleukin-6 [IL-6], C-X-C motif chemokine ligand 8 [CXCL-8], and tumor necrosis factor-alpha) and storage lesion factors (blood pH, potassium, and hemolysis) were evaluated on storage days 0, 7, 14, 21, and 28. Compared to the treated groups, IL-6 and CXCL-8 concentrations during storage were significantly higher in the control (no treatment) group. LR did not show changes in cytokine/chemokine concentrations, and storage lesion presence was relatively mild. IR significantly increased CXCL-8 after 14 days of storage, but IR of leukoreduced blood did not increase CXCL-8 during 28 days of storage. Storage lesions such as hemolysis, increased potassium, and low pH were observed 7 days after IR and storage of blood, regardless of LR. IR of leukoreduced blood is beneficial to avoid immune reactions; however, storage lesions should be considered upon storage.
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Affiliation(s)
- Hayoung Yang
- College of Veterinary Medicine, Chonnam National University, Gwangju 61186, Korea
| | - Woosun Kim
- College of Veterinary Medicine, Chonnam National University, Gwangju 61186, Korea
| | - Junwoo Bae
- College of Veterinary Medicine, Chonnam National University, Gwangju 61186, Korea
| | - Hyunwoo Kim
- College of Veterinary Medicine, Chonnam National University, Gwangju 61186, Korea
| | - Sangki Kim
- College of Industrial Science, Kongju National University, Yesan 32439, Korea
| | - Jihye Choi
- College of Veterinary Medicine, Chonnam National University, Gwangju 61186, Korea
| | - Jinho Park
- College of Veterinary Medicine, Chonbuk National University, Iksan 54596, Korea
| | - Dong-In Jung
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Korea
| | - HongBum Koh
- College of Veterinary Medicine, Chonnam National University, Gwangju 61186, Korea
| | - DoHyeon Yu
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Korea
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Del Lama LS, de Góes EG, Petchevist PCD, Moretto EL, Borges JC, Covas DT, de Almeida A. Prevention of transfusion-associated graft-versus-host disease by irradiation: technical aspect of a new ferrous sulphate dosimetric system. PLoS One 2013; 8:e65334. [PMID: 23762345 PMCID: PMC3676402 DOI: 10.1371/journal.pone.0065334] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 04/24/2013] [Indexed: 02/02/2023] Open
Abstract
Irradiation of whole blood and blood components before transfusion is currently the only accepted method to prevent Transfusion-Associated Graft-Versus-Host-Disease (TA-GVHD). However, choosing the appropriate technique to determine the dosimetric parameters associated with blood irradiation remains an issue. We propose a dosimetric system based on the standard Fricke Xylenol Gel (FXG) dosimeter and an appropriate phantom. The modified dosimeter was previously calibrated using a 60Co teletherapy unit and its validation was accomplished with a 137Cs blood irradiator. An ionization chamber, standard FXG, radiochromic film and thermoluminescent dosimeters (TLDs) were used as reference dosimeters to determine the dose response and dose rate of the 60Co unit. The dose distributions in a blood irradiator were determined with the modified FXG, the radiochromic film, and measurements by TLD dosimeters. A linear response for absorbed doses up to 54 Gy was obtained with our system. Additionally, the dose rate uncertainties carried out with gel dosimetry were lower than 5% and differences lower than 4% were noted when the absorbed dose responses were compared with ionization chamber, film and TLDs.
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Affiliation(s)
- Lucas Sacchini Del Lama
- Physics Department, School of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo (FFCLRP/USP), Ribeirão Preto, São Paulo, Brazil.
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Treleaven J, Gennery A, Marsh J, Norfolk D, Page L, Parker A, Saran F, Thurston J, Webb D. Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force. Br J Haematol 2010; 152:35-51. [DOI: 10.1111/j.1365-2141.2010.08444.x] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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; 47:1405-11. [PMID: 17655584 DOI: 10.1111/j.1537-2995.2007.01282.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Transfusion-associated graft-versus-host disease (TA-GVHD) is a fatal complication of transfusion of blood products that usually affects immunocompromised patients. Articles reporting this condition in immunocompetent recipients are usually from countries that still have problems in irradiation of blood products. CASE REPORTS This report presents fatal TA-GVHD in four immunocompetent patients referred from rural areas where blood irradiation is still not the routine procedure to our tertiary-care center between July 2004 and July 2005. A similar history and chronological order of events were observed: fresh whole-blood transfusion from relatives, fever, rash, liver dysfunction, diarrhea, and pancytopenia. Skin biopsies demonstrated Grade II to III GVHD involvement. Marrow biopsies showed hypoplasia. In two cases, HLA typing studies were performed. Donors were homozygous for a shared HLA haplotype in the patients. All cases were admitted to the intensive care unit within 3 weeks after transfusions with the diagnosis of sepsis, which rapidly progressed to septic shock and multiorgan failure. Another common observation was Candida albicans growth in blood cultures. Unfortunately, all died despite prompt and appropriate sepsis treatment, along with immunomodulatory therapy. CONCLUSION TA-GVHD is probably more prevalent than reported in the literature. It must be considered in the differential diagnosis, if the patient with a recent transfusion history admits with fever, skin rash, abnormal liver function tests, and pancytopenia associated with hypoplastic marrow. In rural areas where gamma irradiation is not possible, the overall policy of transfusion (e.g., restriction of transfusion indications and alternative methods for pathogen inactivation) should be reassessed.
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Affiliation(s)
- Kemal Agbaht
- Department of Internal Medicine, Medical Intensive Care Unit, Division of Hematology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara 06100, Turkey.
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Affiliation(s)
- Marlis L Schroeder
- Department of Pediatrics and Child Health, University of Manitoba, 2011-675 McDermot Avenue, Winnipeg, Manitoba, Canada R3E 0V9.
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Affiliation(s)
- K G Badami
- Jeevan Blood Bank and Research Centre, 1 Jagannathan Road, Nungambakkam, Madras 600034, India.
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Appleton AL, Sviland L, Pearson AD, Wilkes J, Green MA, Malcolm AJ. Diagnostic features of transfusion associated graft versus host disease. J Clin Pathol 1994; 47:541-6. [PMID: 8063938 PMCID: PMC494748 DOI: 10.1136/jcp.47.6.541] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS To define the immunopathological profile of transfusion associated graft versus host disease (TA-GvHD) to elucidate its pathophysiology and to determine if any features are of diagnostic value. METHODS Nine patients (age range 14-61 years) who developed histologically confirmed TA-GvHD between 1989 and 1992 were studied. Immunohistochemical analysis of frozen and formalin fixed skin biopsy tissue was performed. Sections were stained with antibodies to CD3, CD8, CD4 and HLA-DR, using a routine streptavidin-biotin technique with standard diaminobenzidine development. RESULTS All biopsy specimens showed aberrant positive expression of HLA-DR by epidermal keratinocytes. In four patients, all of whom died, HLA-DR was diffusely expressed throughout the epidermis; in the other five cases keratinocyte expression of HLA-DR was more focal. In all biopsy specimens T cells had infiltrated the dermis and epidermis. In all nine cases CD4+ T helper/inducer cells were the predominant T cells. DISCUSSION Immunohistochemical studies are of value in the diagnosis of TA-GvHD. Aberrant keratinocyte expression of HLA-DR and dermal and epidermal infiltration of CD4+ T cells are immunopathological features of TA-GvHD. Immunohistochemical analysis of skin biopsy tissue using antibodies to these markers is thus a useful investigation in pancytopenic patients presenting with unexplained rashes.
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Affiliation(s)
- A L Appleton
- Department of Pathology, University of Newcastle Upon Tyne, Royal Victoria Infirmary
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Affiliation(s)
- A L Appleton
- Division of Pathology, School of Pathological Sciences, University of Newcastle Upon Tyne, Royal Victoria Infirmary
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Bassukas ID. Is erythema toxicum neonatorum a mild self-limited acute cutaneous graft-versus-host-reaction from maternal-to-fetal lymphocyte transfer? Med Hypotheses 1992; 38:334-8. [PMID: 1491634 DOI: 10.1016/0306-9877(92)90028-b] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Erythema toxicum neonatorum (ETN) is a common, self-limited neonate dermatosis affecting worldwide about 50% of newborns--mostly second and later deliveries--irrespective of sex and race. Its etiology still remains obscure: some reaction of the skin of the newborn in adapting to its new environment is the favorite hypothesis to date. A suggested viral or allergic nature could not be confirmed by adequate agent or antigen isolation respectively. In this paper a hypothesis is presented that ETN is a self-limited acute cutaneous graft-versus-host reaction (GVHR) caused in the transiently immunosuppressed newborn by maternal lymphocytes transferred shortly prior to or during delivery.
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Affiliation(s)
- I D Bassukas
- Department of Dermatology, University Erlangen-Nürnberg, Germany
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Abstract
Acute graft versus host disease (GVHD) is a major complication of bone marrow transplantation. This study was undertaken to characterize the histopathologic alterations in early lesions of GVHD and to improve our understanding about the disease process. Histopathologic and immunoperoxidase studies of skin tissue were carried out in 20 patients of GVHD. Sixty percent had grade II histopathologic changes in the skin, grade I and III changes were observed in 35% and 5% respectively. Follicular involvement could be observed in all cases beyond grade I. Immunoperoxidase study revealed OPD4 (+) (T-helper) cells in dermis and OPD4 (-) (probably cytotoxic/suppressor) cells in epidermis.
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Affiliation(s)
- S P Chaudhuri
- Department of Dermatology and Pathology, Stanford University School of Medicine, California 94305
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Prince M, Szer J, van der Weyden MB, Pedersen JS, Holdsworth RF, Whyte G. Transfusion associated graft-versus-host disease after cardiac surgery: response to antithymocyte-globulin and corticosteroid therapy. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1991; 21:43-6. [PMID: 2036076 DOI: 10.1111/j.1445-5994.1991.tb03000.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A 63-year-old patient developed graft-versus-host disease (GVHD) after the transfusion of stored, random donor red cell concentrates with coronary artery surgery. The disease was characterised by skin rash, fever, diarrhoea, hepatic dysfunction, pancytopenia and the acquisition of cells bearing human leukocyte antigens of a blood donor. Clinical and histologic improvements were noted with antithymocyte-globulin and corticosteroid therapy, as seen in some patients with acute GVHD following allogeneic bone marrow transplantation, but the pancytopenia failed to resolve prior to a fatal cerebral haemorrhage. Early aggressive immunosuppressive therapy may be beneficial for transfusion-associated GVHD but strategies for its prevention by limitation of the use of homologous blood need to be addressed.
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Affiliation(s)
- M Prince
- Alfred Hospital, Melbourne, Vic., Australia
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Spitzer TR, Cahill R, Cottler-Fox M, Treat J, Sacher R, Deeg HJ. Transfusion-induced graft-versus-host disease in patients with malignant lymphoma. A case report and review of the literature. Cancer 1990; 66:2346-9. [PMID: 2245390 DOI: 10.1002/1097-0142(19901201)66:11<2346::aid-cncr2820661116>3.0.co;2-t] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A case of transfusion-induced graft-versus-host disease (GVHD) occurring in a 31-year-old female with Hodgkin's disease in complete remission is reported. Clinical features are similar to 19 other reported cases of transfusion-induced GVHD associated with malignant lymphoma. The lack of relationship with underlying histology or disease stage and the nearly uniformly fatal outcome underscores the importance of prophylactic irradiation of blood products given to patients with malignant lymphoma undergoing therapy.
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Affiliation(s)
- T R Spitzer
- Bone Marrow Transplantation Program, Vincent T. Lombardi Cancer Research Center, Georgetown University, Washington, D.C. 20007
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Affiliation(s)
- K C Anderson
- Division of Tumor Immunology, Dana-Farber Cancer Institute, Boston, MA 02115
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Leitman SF. Use of blood cell irradiation in the prevention of posttransfusion graft-vs-host disease. ACTA ACUST UNITED AC 1989. [DOI: 10.1016/0955-3886(89)90029-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mori S, Kodo H, Ino T, Sakakibara T, Maeda H, Juji T. Postoperative erythrodermia (POED), a type of graft-versus-host reaction (GVHR)? Pathol Res Pract 1988; 184:53-9. [PMID: 2976493 DOI: 10.1016/s0344-0338(88)80191-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Postoperative erythrodermia (POED) is a rare disease appearing several days after surgery for which blood transfusion has been required, characterized by erythrodermia, fever, pancytopenia, hepatic insufficiency or diarrhea. Most affected patients die within four weeks. The etiology remains unknown, but some assume it to be a type of graft-versus-host reaction (GVHR) caused by transfused lymphocytes. In this study, skin biopsies taken from 9 POED patients were examined to clarify whether POED is a type of GVHR. In seven samples, changes compatible with GVHR, such as lymphocyte infiltration in the basal layer and occasional eosinophilic or vacuolar degeneration of the epidermal cells, with occasional satellitosis, were noted. Immunopathologically, infiltrating lymphocytes mostly expressed suppressor/cytotoxic T cell markers like those in GVHR. Meanwhile, immunostaining with anti-HLA-A type specific antibodies failed to differentiate infiltrating lymphocytes from host cells. Thus, the present morphologic and in vivo marker study suggested POED to be a type of GVHR, while in vivo HLA-A typing showed two contradictory possibilities: first, that POED is a GVHR in which major histocompatibility antigen-matched donor lymphocytes attack host cells, and secondly that POED is not a GVHR, the infiltrating lymphocytes being of host origin.
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Affiliation(s)
- S Mori
- Department of Pathology and Internal Medicine, University of Tokyo, Japan
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Matsushita H, Shibata Y, Fuse K, Kimura M, Iinuma K. Sex chromatin analysis of lymphocytes invading host organs in transfusion-associated graft-versus-host disease. VIRCHOWS ARCHIV. B, CELL PATHOLOGY INCLUDING MOLECULAR PATHOLOGY 1988; 55:237-9. [PMID: 2900576 DOI: 10.1007/bf02896581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We report a method of sex chromatin analysis of lymphocytes separated from host organs in transfusion-associated graft-versus-host disease (GVHD), which enabled the demonstration of invasion by donor lymphocytes. The lymphocytes examined were separated from deparaffinized tissue blocks of skin, spleen and bone marrow from two female patients with transfusion-associated GVHD by incubation in 0.5% pepsin. The tissues had been removed at autopsy and fixed in formalin. Sex chromatin analysis was performed by fluorescence microscopy on separated lymphocytes stained with 0.005% quinacrine dihydrochloride. By this means Y chromatin-positive (i.e. male) lymphocytes were demonstrated in the skin, spleen and bone marrow of both female patients.
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Affiliation(s)
- H Matsushita
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
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Kessinger A, Armitage JO, Klassen LW, Landmark JD, Hayes JM, Larsen AE, Purtilo DT. Graft versus host disease following transfusion of normal blood products to patients with malignancies. J Surg Oncol 1987; 36:206-9. [PMID: 3316850 DOI: 10.1002/jso.2930360311] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A patient undergoing treatment with cytotoxic chemotherapy for Hodgkin's disease developed graft versus host disease (GVHD) following a transfusion of packed red cells. This is the 28th reported patient with a malignancy who did not have a bone marrow transplant and developed GVHD after transfusion of normal blood or blood products. All patients had received cytotoxic chemotherapy prior to acquiring GVHD. The underlying malignancies included lymphoma, acute leukemia, neuroblastoma, rhabdomyosarcoma, and glioblastoma. Twenty-three of the 28 patients died of GVHD. The incidence of transfusion-related GVHD in this patient population is low but the illness is often fatal as treatment is largely ineffective. Transfusion-related GVHD can be prevented by irradiating all blood products with 1500 rad prior to administration.
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Affiliation(s)
- A Kessinger
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha 68105
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Pritchard SL, Rogers PC. Rationale and recommendations for the irradiation of blood products. Crit Rev Oncol Hematol 1987; 7:115-24. [PMID: 3311424 DOI: 10.1016/s1040-8428(87)80021-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Blood products are often irradiated to prevent proliferation of lymphocytes which could cause graft-vs.-host disease in immunocompromised recipients. The effects of irradiation on the function of blood components is discussed. It is concluded that 1500 rad is sufficient to prevent lymphocyte proliferation and production of graft-vs.-host disease in vivo, although 10 to 20% of lymphocytes are still capable of proliferation in vitro after 1500 rad. Neutrophils and erythrocytes are extremely radioresistant and their function is unaffected by 1500 rad. There is limited data to suggest that platelet yields may be slightly reduced following irradiation. Guidelines for the use of irradiated blood products are suggested.
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Affiliation(s)
- S L Pritchard
- Department of Pediatrics, University of British Columbia, B.C. Children's Hospital, Vancouver, Canada
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Abstract
A 2-year-old girl being prepared for a bone marrow transplant for treatment of stage IV neuroblastoma suffered a fatal graft v host (GVH) reaction following a transfusion on nonirradiated packed RBC. GVH disease is a recognized complication of transfusion in patients with leukemia and lymphoma and is a frequent complication following bone marrow transplantation. GVH disease has also been reported in pediatric patients with solid tumors who have received sufficient chemotherapy to render them immunocompromised. GVH disease can be prevented by irradiating all blood products with at least 1,500 rad for patients having total lymphocyte counts less than 1,000/microL or for those who have received greater than 30 mg/kg/d of Cytoxan.
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Abstract
The natural history of human cutaneous graft-versus-host disease (GVHD) has been described as a consequence of allogeneic bone-marrow transplants, but syngeneic and even autologous marrow transplants are now being recognized as being associated with similar, albeit less severe, changes. The histopathologic changes of both acute and chronic GVHD have been reported and show similarities to other idiopathic cutaneous disorders. The T-lymphocyte, specifically an OKT8+ cell, seems to play a major role in the pathogenesis of cutaneous GVHD. A recently described in vitro model of human cutaneous GVHD using skin explants co-cultured with lymphocytes holds some promise as a technique to further explore lymphocyte-skin interactions.
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