Lowenthal R M, Challis D R, Griffiths A E, Chappell R A, Goulder P J
Clinical Haematology and Medical Oncology Unit, Royal Hobart Hospital, Tasmania, Australia.
Transfusion. 1993 Jun;33(6):524-9. doi: 10.1046/j.1537-2995.1993.33693296818.x.
Patients who are heavily immunosuppressed, such as those undergoing intensive anti-cancer chemotherapy, are at risk for development of accidental engraftment and graft-versus-host disease when they undergo transfusion with cellular blood components, a condition known as transfusion-associated graft-versus-host disease (TA-GVHD). To prevent this complication, it is routine to irradiate such blood components prior to their transfusion, although the minimum irradiation dose required is uncertain. The development of probable TA-GVHD is reported in a 10-year-old child following transfusions of platelets and packed red cells that had been irradiated at a nominal dose of 15 Gy. The transfusions were given during treatment for relapse of acute myeloid leukemia. Although the child developed complications including exfoliative dermatitis, delayed bone marrow regeneration, renal failure requiring dialysis, and respiratory failure requiring assisted respiration, she recovered from the episode of TA-GVHD after treatment with high-dose methylprednisolone and antithymocyte globulin. However, her leukemia relapsed, and she died. This experience suggests that the irradiation of cellular blood components at a nominal dose of 15 Gy prior to their transfusion to heavily immunosuppressed patients may be insufficient to prevent TA-GVHD.
重度免疫抑制的患者，如正在接受强化抗癌化疗的患者，在输注细胞血液成分时，有发生意外植入和移植物抗宿主病的风险，这种情况称为输血相关移植物抗宿主病（TA-GVHD）。为预防这种并发症，在输血前对这类血液成分进行辐照是常规操作，尽管所需的最低辐照剂量尚不确定。据报道，一名10岁儿童在输注了标称剂量为15 Gy辐照的血小板和浓缩红细胞后发生了可能的TA-GVHD。这些输血是在急性髓系白血病复发的治疗期间进行的。尽管该儿童出现了包括剥脱性皮炎、延迟性骨髓再生、需要透析的肾衰竭以及需要辅助呼吸的呼吸衰竭等并发症，但在接受大剂量甲泼尼龙和抗胸腺细胞球蛋白治疗后，她从TA-GVHD发作中康复。然而，她的白血病复发，最终死亡。这一经验表明，在向重度免疫抑制患者输血前，以标称剂量15 Gy对细胞血液成分进行辐照可能不足以预防TA-GVHD。
