Transplant pathology: transfusion-associated GVHD: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Transplant pathology: transfusion-associated GVHD

Sample item

A 62-year-old man treated with fludarabine for chronic lymphocytic leukaemia develops fever, a maculopapular rash, diarrhoea and pancytopenia 10 days after a non-irradiated blood transfusion. Which measure would have prevented this complication?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Gamma irradiation of cellular blood components

Transfusion-associated graft-versus-host disease occurs when donor T lymphocytes engraft in an immunocompromised recipient and attack host skin, gut, liver and marrow, so it carries a very high mortality. Irradiation of cellular components inactivates donor lymphocytes and is the standard preventive measure in patients receiving purine analogues or undergoing stem cell transplantation.

Option by option

  • A. Leucodepletion filters as the sole precaution

    Leucodepletion does not reliably prevent transfusion-associated graft-versus-host disease and cannot replace irradiation.

  • B. Gamma irradiation of cellular blood components (correct)

    Correct. Irradiation prevents donor lymphocytes from proliferating in the recipient.

  • C. Selecting CMV-seronegative donors

    CMV-seronegative selection reduces CMV transmission and does not prevent donor T-cell engraftment.

  • D. Washing red cells with saline

    Washing mainly removes plasma proteins and does not inactivate donor lymphocytes reliably.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is B, Gamma irradiation of cellular blood components. Transfusion-associated graft-versus-host disease occurs when donor T lymphocytes engraft in an immunocompromised recipient and attack host skin, gut, liver and marrow, so it carries a very high mortality.

Why is "Leucodepletion filters as the sole precaution" not the answer?

Leucodepletion does not reliably prevent transfusion-associated graft-versus-host disease and cannot replace irradiation.

Why is "Selecting CMV-seronegative donors" not the answer?

CMV-seronegative selection reduces CMV transmission and does not prevent donor T-cell engraftment.

Why is "Washing red cells with saline" not the answer?

Washing mainly removes plasma proteins and does not inactivate donor lymphocytes reliably.

What concept does this question test?

It tests Transplant pathology: transfusion-associated GVHD in Pathology. Irradiation of cellular components inactivates donor lymphocytes and is the standard preventive measure in patients receiving purine analogues or undergoing stem cell transplantation.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Transplant pathology: transfusion-associated GVHD?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.