A severely immunocompromised female patient requires a blood transfusion. To prevent GVHD, the physician will order:
A. diphenhydramine hydrochloride (Benadryl).
B. The transfusion to be administered slowly over several hours.
C. Irradiation of the donor blood.
D. acetaminophen (Tylenol).
Correct Answer: C. Irradiation of the donor blood.
This process eliminates white blood cell functioning, thus, preventing GVHD. Cellular blood components are irradiated prior to transfusion to prevent the proliferation of viable T lymphocytes which are the immediate cause of Transfusion Associated-Graft Versus Host Disease (TA-GVHD).
Option A: Diphenhydramine HCl is an antihistamine. Its use prior to a blood transfusion decreases the likelihood of a transfusion reaction. TA-GVHD, a rare complication (fewer than one per million transfusions result in TA-GVHD), has a fatality rate greater than 90%.
Option B: Option 2 will not prevent GVHD. TA-GVHD is a rare but usually fatal complication of transfusion. The disease occurs when donor lymphocytes engraft in a susceptible recipient. These donor lymphocytes proliferate and damage target organs, especially bone marrow, skin, liver, and gastrointestinal tract. Typically the condition presents 10-14 days after transfusion with rash (erythroderma), pancytopenia, and abnormal liver function. There is a long time between transfusion and presentation in neonates. The mortality rate of TA-GVHD approaches 100%.
Option D: The use of acetaminophen prevents and treats the common side effects of blood administration caused by the presence of white blood cells in the transfusion product: fever, headache, and chills.