Transfusion-associated graft-versus-host disease and irradiated blood products as its preventive measure

In this article, the outline of TA-GVHD is presented and its preventive measures, especially the effects of radiation exposure of transfusion blood, is reported. TA-GVHD is a transfusion complication with the highest mortality. In Japan, 1 of 659 patients who underwent cardiac surgery suffers this disease. If this is caused by on way matching of HLA antigen type, 1 of 312 patients are to be observed in Japanese (Europe, 1/1024; North America, 1/797). Furthermore, the primary diseases of 171 patients whose definitive diagnosis was TA-GVHD were chest vascular surgery diseases in 67, malignant tumors in 61, and pediatric diseases in 14. The relative risk rates of cardiac surgery patients are 3 times higher than that of cancer patients. The current most effective preventive therapy for TA-GVHD is radiotherapy. The ions produced by H2O decomposition due to radiation destroy cells. Since TA-GVHD often appears in the case of using fresh blood, authors always use irradiated blood for infusion when blood was collected within 72 hours regardless of the subject diseases. In the authors' hospitals, there have been no report of TA-GVHD between December 1993 and August 1995. Radiological effects on lymphocytes, erythrocytes, platelets, and granulocytes were also studied. As the other preventive measures, lymphocytes eliminating filter, MAP-erythrocytes, and ultraviolet irradiation are also reported. The current most safe blood is therefore considered the blood of which lymphocytes were eliminated within 24 hours after collection and exposured to irradiation. (S.Y.). 57 refs