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First Aid for the USMLE Step 1 (2023)
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Graft Versus Host Disease

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Graft Versus Host Disease

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10 KEY FACTS
PATHOPHYSIOLOGY
Graft T Cell Sensitization Against Host MHC Antigens
Giraffe-graft Tennis Ball against Host MHC Ant-gem

Graft versus host disease occurs due to grafted immunocompetent T cells proliferating in the immunocompromised host. These will cause rejection to the host cells and graft T cell sensitization against host MHC antigens. In the end, it can cause severe organ dysfunction.

Graft Recognizes Host as "Foreign"
Giraffe-graft Recognizing Host as Foreign

Graft recognizes the host as "foreign." HLA mismatches will increase graft versus host disease occurrence. The most common HLA mismatches are HLA-A, HLA-B, and HLA-DR antigens.

Type IV Hypersensitivity
(4) Fork Hiker-sensitive-crying

Graft versus host disease is a type IV hypersensitivity.

SIGNS AND SYMPTOMS
Diffuse Maculopapular Rash
D-fuse Mac-glow-papule-people

The most common skin lesion is a maculopapular rash, which can spread diffusely and confluent. Patients can experience itchiness and pain, and the rash may be seen in the palms, soles, shoulders, and nape of the neck. Bullous lesions with toxic epidermal necrolysis can be seen in severe conditions.

Jaundice
Jaundice-janitor

Jaundice can occur as a manifest from graft versus host disease liver injury. It is typically found as cholestatic jaundice, increased serum alkaline phosphatase (ALP), and hyperbilirubinemia.

Diarrhea
Toilet

The most common GI manifestation of graft versus host disease is diarrhea and abdominal pain, and it is typically found as diarrhea secretory. It can manifest as watery and may progress to bloody.

Hepatosplenomegaly
Liver-and-spleen-balloons

Patients with graft versus host disease can be seen with hepatosplenomegaly. Liver involvement is rarely seen. It usually occurs together with GI or cutaneous manifestation.

ASSOCIATIONS
Severe Immunocompromised Patients
Moon-compromised by bacteria and viruses

Severe immunocompromised patients are at risk of having graft versus host disease.

Bone Marrow and Liver Transplantation
Bone Liver Train-plant

Graft versus host disease usually occurs in bone marrow and liver transplants, organs that are rich in lymphocytes. Bone marrow transplantation is the most common cause of graft versus host disease.

Transfusion of Non-irradiated Blood
Transfusion-IV Nun-radiation-radio

Transfusion of non-irradiated blood can cause a patient to have graft versus host disease. This can be prevented by using blood product irradiation which causes lymphocyte inactivatons.

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