Acute graft-versus-host disease (GvHD) is a serious complication that can occur after an allogeneic hematopoietic stem cell transplant. It occurs when the donor’s immune cells recognize the recipient’s tissues as foreign and mount an immune response against them. Acute GvHD typically develops within days following the transplant and can affect multiple organs, primarily the skin, liver, and gastrointestinal tract. The condition is driven by the activation of donor T cells that attack the host’s tissues.

Signs of Acute GvHD
Skin rashes
One of the most common symptoms of acute GvHD is reddened skin areas or rashes. These rashes can resemble sunburns and may cause the skin to be itchy or painful. They can start at the neck, ears, shoulders, or the palms of the hand, and in some cases, they can begin forming at the soles of the feet. As the disease progresses, the rashes can spread to other parts of the body. They can often be accompanied by intense itching, also known as pruritus. The redness and inflammation accompanied by rashes can cause erythema. This can cause blisters and peeling of the skin in intense cases.

Gastrointestinal discomfort
This is another common sign of the condition to look out for. The patients may experience moderate to severe abdominal pain following the grafting procedure. Some may even have watery or bloody diarrhea along with mucosal damage. Nausea and vomiting resulting from the condition can cause nutritional imbalance, insufficiency, and modified fluid balance. Patients might alternatively have to deal with constipation. It can cause severe bowel obstruction due to a lack of proper bowel movements.

Jaundice
Acute GvHD also impacts the patient’s liver. The increased bilirubin levels in the patient’s body lead to yellowing of the eyes, nails, and skin. Aside from bilirubin, there is also an observed elevation in the levels of other liver enzymes. This includes alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase. On physical examination and diagnostic testing, it may also be observed that the patient has an enlarged liver.

Diagnosis
The doctor may suggest various diagnostic tests to detect the problem. The process can require the patient to undergo various lab and imaging tests. These results can be used to diagnose, monitor, and manage the problems presented with the disease. The tests include:

• Abdominal x-ray
• Liver function tests
• MRI
• PET scan
• CT scan abdomen and CT chest
• Liver biopsy
• Capsule endoscopy

The biopsy sites include mucous membranes of the mouth and skin, as suggested by the doctor.

Management options
A doctor may suggest certain prescription treatments as the first line of treatment to manage the condition. These treatments are used as the standard initial approach for patients with acute GvHD. The doctor may decide the quantity of the prescription treatment to be administered based on the severity of the patient’s condition and their response to the treatment. Other alternative options include stem cells and immunosuppressors. Doctors may also prescribe other chemical compounds that have been proven to be effective treatments.