Graft-versus-host disease following transfusion of red cell concentrates preserved in mannitol-adeninne-phosphate solution

A 79-year-old man with prostatic hypertrophy was performed trans-ureteral resection of prostate, and the transfusion of red cell concentrates stored in mannitol-adeninne-phosphate solution (RC-MAP) was required because of massive postoperative bleeding, despite of preparation for the autologous blood transfusion. On postoperative day 7 high fever developed, followed by widespread erythema, liver dysfunction, watery diarrhea and pancytopenia. Skin biopsy findings showed typical changes of transfusion associated graft-versus-host disease (TA-GVHD). Despite intensive treatment with methylpredonisolone, cyclosporine A, colony-stimulating factor and other supportive therapy, he died day 31 after surgery. The containing of foreign DNA fragments in his blood was detected by the analysis of microsatellite DNA polymorphism of his finger nail and peripheral blood.We emphasize that the transfusion of RC-MAP can cause TA-GVHD though the contaminated lymphocyte of RC-MAP is markedly reduced compared with the ordinary packed red cells.