Usual cause
Viable T lymphocytes in the transfused component engraft in the recipient and react against tissue antigens in the recipient.
Incidence
Rare. Severely immunocompromised recipients are at greatest risk. Has been reported in immunologically normal recipients heterozygous for a tissue antigen haplotype for which the donor is homozygous, especially directed donations from family members.
Main clinical features
Fever, rash, liver function abnormalities and pancytopenia. Usually fatal.
Investigation
Skin biopsy. Demonstrate donor leucocyte engraftment.
Intervention
Supportive care. Prevention by gamma irradiation. Inform ARCBS