Possible Graft-versus-Host Reaction after Intrauterine Transfusion for Rh Erythroblastosis Fetalis

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Abstract
An illness characterized by jaundice, aplastic anemia and striking histiocytic reaction in the bone marrow developed in an eight-week-old infant who survived three intrauterine transfusions for Rh erythroblastosis fetalis. Culture of peripheral blood lymphocytes suggested two populations of lymphocytes based on differences in Y-chromosome length. One of these resembled that of one of the donors of the intrauterine blood transfusions. In spite of initial hematologic improvement the infant's condition deteriorated, with multiple infections and progressive weight loss until death at 13 weeks of age. Although lymphoid and thymic atrophy were evident at autopsy these changes were considered to reflect atrophy (secondary to a graft-versus-host reaction) rather than primary immunologic deficiency disease. This observation supports recommendations of others that blood intended for transfusion to the fetus be first rendered free of viable lymphocytes.