Background: Posttransfusion graft-versus-host disease (PT-GVHD) is underdiagnosed and underreported. Risk factors predisposing to PT-GVHD in newborn recipients, the clinical manifestations of the disease in newborns, and its mechanism are not well characterized.
Study design and methods: A literature review identified 27 cases of PT-GVHD in newborns in Japan. Detailed information on volume of blood transfused, donor(s), and clinical course was analyzed. Infants with known immunodeficiency were excluded.
Results: Of 27 newborns, 20 were premature and 7 were full-term. Thirteen premature neonates were transfused frequently because of anemia; in 10 cases, exchange transfusion was performed. Fresh blood (<or=72 hours after donation) and blood from family member(s) were transfused to 25 and 22 neonates, respectively. The clinical manifestations of PT-GVHD developed later after transfusion than is reported in adults; the median intervals were: fever, 28 days; erythematous rash, 30 days; leukopenia, 43 days; and death, 51 days. Thymic damage was a striking feature among newborns. Two thirds of the cases of PT-GVHD were associated with overwhelming infections, and all patients died in spite of various treatments.
Conclusion: These data suggest that cellular blood components, especially those from family members, should be irradiated before transfusion to premature and full-term neonates. Extrathymic and/or thymic semitolerance for allogeneic-donor cytotoxic T-lymphocytes may explain the longer period of latency before the onset of clinical manifestations and the longer course of disease before death in newborns than are noted in adults, as well as the fewer than expected reported cases of PT-GVHD in neonates.