Transfusion-associated graft-versus-host disease in an immunocompetent patient

Article Abstract:

Graft-versus-host disease is seen in transplant recipients in which the donor's tissues "reject" the recipient's tissues. It develops rarely after blood transfusions, when the transfused white blood cells attack the recipient's blood cells. Symptoms of transfusion-associated graft-versus-host disease (TA-GVHD) include fever, skin rash, vomiting, diarrhea, and bone marrow failure: death results in death within a few weeks in 90 percent of the cases. Most cases of TA-GVHD occur in recipients whose own immune systems are too impaired to fight off the donor's attacking white blood cells. A case is reported of a transfusion recipient with an intact immune system who developed TA-GVHD. The patient was a 72 year old woman with kidney cancer who received a transfusion of seven units of blood, 5 from unrelated donors and two from her daughters, who were the children of the patient and her first cousin. Twelve days after the transfusion, the patient was hospitalized for fever and vomiting, and died 8 days later. When blood is transfused, it is matched for the A, B, O and Rh groups. HLA tissue typing, which tests for the presence of certain molecules on the blood cells, is far more sophisticated and is generally only done when an organ is being transplanted. Perfect HLA matches are not needed for successful blood transfusion in most cases. The five unrelated donors agreed to HLA tissue typing, but the two daughters refused. None of the five unrelated donors had HLA types that should have provoked TA-GVHD. Since that the patient and her husband were blood relatives, each could have passed on an identical HLA type to the daughters. Since the mother's HLA tissue typing revealed that she had received two different HLA types from her parents, her daughters' blood cells would have recognized only half of their mother's HLA types as like their own, and thus, their white blood cells would have seen the mother's tissues as foreign, provoking TA-GVHD. Given the recent trend to directed (planned, from known donors) blood donations, blood from relatives should be irradiated to diminish the likelihood of TA-GVHD. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Case studies, Directed blood donations, Prevention, Graft versus host reaction, Graft vs. host disease

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Once-daily aminoglycoside dosing in immunocompetent adults: a meta-analysis

Article Abstract:

Antibiotic injections given once a day and those given in traditional quantities appear to be equally effective. However, once-a-day treatment seems to be less toxic. Researchers pooled results from 13 studies that compared once a day and standard antibiotic treatment. The bacterial infection cure rates were similar for both treatment groups. The risk for death, kidney poisoning, and significant hearing loss was 9%, 13%, and 33% lower with once a day treatment as compared to standard treatment. Once a day treatment may also be more cost-effective due to reduced requirements for nursing time. Once a day treatment also allows for a more consistent treatment schedule.

Antibiotics, Dosage and administration, Aminoglycosides

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Safety of the blood supply in the United States: opportunities and controversies

Article Abstract:

Additional measures to increase blood supply safety could paradoxically lead to increased risks, as well as a poor allocation of health-care resources. More stringent donor qualifications, more sensitive viral detection methods, and viral inactivation techniques carry their own risks. The point at which the risk exceeds the potential benefit can be seen in cost-effectiveness studies of these interventions. However, such analyses does not take into account emotional influences, such as the fear of HIV infection, that appear to be directing the push toward a zero-risk blood supply.

Blood collection and preservation, Safety and security measures, Blood banks

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