Which patient is at risk of developing graft-vs-host disease?

Graft-versus-host disease (GVHD) is a condition that occurs when transfused immune cells, typically found in lymphocyte-rich components of blood, mount an attack against the recipient's tissues. This is particularly a concern when the donor’s immune cells recognize the recipient's tissues as foreign.

Individuals who receive blood products from immediate family members are at increased risk for developing GVHD. This is because family members often share similar human leukocyte antigen (HLA) types, but can still have enough immunological differences that trigger the condition. The risk is specifically heightened when blood or blood components that contain viable T lymphocytes (such as whole blood or certain types of leukocyte-rich platelet transfusions) are transfused.

In contrast, full-term infants, those with a history of febrile transfusion reactions, and patients with a positive direct antiglobulin test are not at a significant risk for developing GVHD. Full-term infants have immature immune systems that are typically more resilient to such events. A history of febrile transfusion reactions is generally an indication of a recipient’s immune response to antibodies or other components in blood products, rather than the presence of foreign T cells causing GVHD. Lastly, a positive direct antiglobulin test