Not true about graft versus host reaction ?
Ans. is None (all are true) Pathological manifestations of graft versus host disease (GVHD) o There are three principal target tissues affected in GVHD:- Skin, liver and gut. o GVHD disease may be acute or chronic A. Acute GVHD :-Acute GVHD occurs within 100 days (usually 10-50 days) of bone marrow transplantation. The manifestations of acute GVHD are:? 1. Skin o The most common tissue affected in acute GVHD is the skin, with over 80% of patients with GVHD manifesting skin eruption. o The typical skin presentation consists of a maculopapular rash that can resemble a sunburn. o Histological findings are:- (i) Perivascular mononuclear infiltrates (ii) Vacuolar degradation of dermo-epidermal junction (iii) Dyskeratotic cells or eosinophilic bodies in the epidermis (iv) Epidermolysis & bullae (v) Denudation of epidermis (separation of epidermis from dermis) 2. Gut J The primary clinical manifestation of gut GVHD is diarrhea and abdominal pain. o There is lymphocytic infiltrates at the crypts with accompnied necrosis and dropout of crypt cells. 3. Liver o Lymphocytic infiltrates in the interlobular and marginal bile ducts are characteristic histopathologic findings. o This results in hepatitis with necrosis of hepatocytes and bile duct epithelial cells o There is inflammation of the parenchyma and poal tracts. o These findings lead to clinically identifiable cholestatic picture. B. Chronic GVHD :- It occurs after 100 days of bone marrow transplantation. Manifestations are :1.Skin o Extensive cutaneous injury, with destruction of skin appendages and fibrosis of the dermis. Gut o Damage to GIT may result in necrosis, ulceration, fibrosis and strictures. Liver o The findings of liver damage are :? (i) Poal tract inflammation (ii) Selective bile duct destruction (iii) Endothelitis of poal vein and hepatic vein radicles, in which a subendothelial lymphocytic infiltrate lifts the endothelium from its basement membrane. (iv) Intrahepatic cholestasis Role of liver biopsy in GVHD o Evaluation of liver biopsies in the setting of acute GVHD is usually not required, because skin or GI tract biopsies are usually sufficient to establish a diagnosis and the risks associated with liver biopsy in the early post-operative period are unacceptably high. However, because abnormal liver function tests often persist despite improvement in other organs after treatment, liver biopsy may be needed to exclude coexistent disease such as viral infection. Therefore, in acute GVHD liver biopsy contributes an impoant role in the exclusion of other causes of hepatic injury. o In contrast, liver biopsy is an impoant diagnostic test in establishing a diagnosis of chronic GVHD after bone marrow transplantation.
Not true about graft versus host reaction ?
Bile duct damage
Intrahepatic cholestasis
None