Which of the following is the earliest clinical sign of acute graft-versus-host disease (GVHD)

Appeared in: AIIMS M.Sc. Nsg Entrance exam-2026

Explanation

Anorexia (loss of appetite) is a primary manifestation of acute GVHD, specifically involving the upper gastrointestinal (GI) tract.
According to clinical staging criteria, persistent anorexia is classified as a Stage 1 sign of upper GI GVHD.
While a skin rash is often the very first sign of acute GVHD overall, anorexia is considered the earliest GI symptom among the given options, often preceding the onset of voluminous diarrhea.

Option A: Hypertension (high blood pressure) is not associated with acute GVHD. The pathophysiology of GVHD does not lead to an increase in blood pressure.
Option C: This is a duplicate of the first option and is incorrect for the same reasons. Hypertension is not a clinical sign of acute GVHD.
Option D: While acute diarrhea is a hallmark sign of GI GVHD, it is typically not the earliest. It represents a progression of the disease after initial, more subtle symptoms.

Clinical Relevance

Nursing practice connection: Knowing Early clinical signs of acute Graft-versus-Host Disease (GVHD) helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses play a critical role in identifying early GVHD. Meticulous assessment is key for early intervention and improved outcomes.
Key nursing assessments include daily head-to-toe skin checks, strict monitoring of intake and output, and detailed stool charting (frequency, volume, consistency).
Promptly reporting early signs like anorexia or a new rash allows the medical team to start treatment before the disease becomes severe and harder to control.

How to Approach the Question

First, identify the core of the question: it's asking for the 'earliest' sign of acute GVHD from the given list.
Recall the pathophysiology of acute GVHD, where donor T-cells attack host organs, primarily skin, GI tract, and liver.
Consider the typical progression of symptoms. Skin rash is usually first overall, but it's not an option. For GI symptoms, think about the sequence: does loss of appetite (anorexia) or diarrhea come first?
Evaluate each option. Anorexia is a subtle, early sign of GI distress. Acute diarrhea is a more significant and often later sign. Hypertension is not related.
Based on this progression, determine that anorexia is the earliest sign among the choices.
Note any errors in the question, such as the duplicate option, but answer based on the valid choices.

Concept Tested & Keywords

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1368-1370

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