Arsura E L, Bertelle A, Minkowitz S, Cunningham J N, Grob D
Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219.
Arch Intern Med. 1988 Sep;148(9):1941-4.
Since the advent of bone marrow transplantation, a vexing clinical problem is that of acute graft-vs-host disease (GVHD). A less well-recognized disorder is that of GVHD in patients receiving blood products containing immunocompetent lymphocytes. Transfusion-associated (TA)-GVHD has a lower incidence and higher mortality (greater than 90%) than bone marrow transplantation-GVHD and until now has been limited to patients with hereditary or acquired immunologic deficits and to patients immunocompromised by chemotherapy for malignant neoplasms. We presently describe a patient who underwent coronary artery bypass graft surgery and who suffered what we believe was TA-GVHD. This diagnosis is supported by considering the chronology of events (in particular, blood transfusion), clinical features (fever, rash, abnormal results of liver function tests, diarrhea, and pancytopenia), and a skin biopsy specimen that revealed basal cell vacuolation and lymphocyte satellitosis that are considered characteristic for this disorder. We believe TA-GVHD can occur in previously immunocompetent patients who receive transfusions of blood products containing functioning lymphocytes and that this awareness will lead to the discovery of additional cases and a better understanding of this disorder.
自骨髓移植出现以来，一个棘手的临床问题就是急性移植物抗宿主病（GVHD）。一种较少被认识的病症是接受含有免疫活性淋巴细胞的血液制品的患者发生的GVHD。与骨髓移植相关性GVHD相比，输血相关（TA）-GVHD的发病率较低，但死亡率较高（超过90%），并且到目前为止仅限于患有遗传性或获得性免疫缺陷的患者以及因恶性肿瘤化疗而免疫受损的患者。我们目前描述了一名接受冠状动脉搭桥手术的患者，他患上了我们认为是TA-GVHD的疾病。这一诊断得到了以下几方面的支持：事件发生的时间顺序（特别是输血情况）、临床特征（发热、皮疹、肝功能检查结果异常、腹泻和全血细胞减少）以及皮肤活检标本显示的基底细胞空泡化和淋巴细胞卫星现象，这些被认为是该病症的特征。我们认为TA-GVHD可发生于接受含有功能淋巴细胞的血液制品输血的既往免疫功能正常的患者，并且这种认识将促使发现更多病例并更好地了解这种病症。
