Kosuga K, Ohgami N, Okuda K, Kinoshita H, Taniwaki S, Hisatomi K, Shimada S, Nakayama T, Ohishi K
Department of Surgery, Kurume University School of Medicine, Japan.
Kurume Med J. 1993;40(4):193-9. doi: 10.2739/kurumemedj.40.193.
A case of transfusion-associated graft versus host disease (TA-GVHD) following hepatectomy for hepatocellular carcinoma is described in a 53 year-old male patient. The intraoperative bleeding was estimated to be 1220 ml, and he was transfused with 4 units of fresh whole blood. On postoperative day (POD) 12, a fever of 38 degrees C developed, followed by a systemic erythema on POD 14, and a marked progressive leukopenia starting from POD 19. The patient died of multiple organ failure (MOF) on POD 29. Just before death, the results of skin, bone marrow, and liver biopsies had no physical evidence of GVHD. TA-GVHD was found in the HLA typing of the patient's family. This TA-GVHD case was considered to be a reduced immunity due to severe surgical stress or preoperative transcatheter arterial embolization (TAE), in view of the fact that he was transfused with fresh whole blood during the operation. TA-GVHD has frequently been reported in patients after open heart surgery, but also after hepatectomy. It is therefore necessary to take all available means to prevent it by restricting the use of blood preparations as much as possible, and if hetero blood transfusions are performed, blood should be irradiated prior to transfusion.
一名53岁男性患者在因肝细胞癌行肝切除术后发生了一例输血相关移植物抗宿主病（TA-GVHD）。术中估计出血量为1220毫升，他接受了4单位新鲜全血输血。术后第12天出现38摄氏度发热，术后第14天出现全身性红斑，术后第19天开始出现明显的进行性白细胞减少。患者于术后第29天死于多器官功能衰竭（MOF）。临死前，皮肤、骨髓和肝脏活检结果未发现GVHD的体征。在患者家属的HLA分型中发现了TA-GVHD。鉴于该患者在手术期间接受了新鲜全血输血，考虑到严重手术应激或术前经导管动脉栓塞术（TAE）导致免疫功能降低，该TA-GVHD病例被认为是这种情况。TA-GVHD在心脏直视手术后的患者中经常有报道，但肝切除术后也有。因此，有必要采取一切可用手段预防TA-GVHD，尽可能限制血液制品的使用，如果进行异体输血，输血前应进行血液辐照。
