Case Report - Transfusion-associated graft-versus-host disease in an immunocompetent individual

A 9 months old immunocompetent male baby was admitted with high grade fever, erythematous maculo-papular rash and frequent loose stools. He was unwell three weeks prior, with febrile illness and anemia, for which he was transfused 2 units of non irradiated whole blood from first-degree family donors (father and mother), in a private hospital. Seven days after transfusion, he became symptomatic. Investigations revealed elevated liver enzymes, elevated bilirubin levels and progressive pancytopenia. Clinical findings and results of skin biopsy and bone marrow examination were consistent with transfusion-associated graft-versus-host disease. He was treated with steroids, Cyclosporin, broad spectrum antibiotics and supported by irradiated blood components. He died on day 10, post admission and day 31, post transfusion, despite intensive medical care.