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Blood Component Irradiation

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Irradiation of blood components

Blood components may contain small numbers of lymphocytes from the blood donor. In the severely immunocompromised host these can engraft causing Transfusion-associated Graft versus Host Disease (TAGVHD). This condition is almost invariably fatal.

Irradiation of blood components is aimed at preventing reproduction of donor lymphocytes that may be contained in the donation. Frozen plasma products and plasma derivatives do not require irradiation.

Haematopoetic stem cells/bone marrow is not irradiated.

 Some units prefer to irradiate blood components for all patients to avoid at risk patients receiving non-irradiated components in error. Others irradiate blood components only for at risk patients.

Currently patients under the care of Starship hospital all receive irradiated blood regardless of their disease or treatment while those under the care of CHOC in Christchurch receive irradiated products only as recommended by the New Zealand Blood Service.

Irradiated blood products request form.

If irradiated components are not available for a patient who should receive them, and transfusion is considered urgent, please discuss with the on-call oncologist.

If a patient needs a transfusion semi-urgently and irradiated components are not available, try to avoid transfusion especially in those patients considered most at risk (as determined by the New Zealand Blood Service1):

  • Allogeneic haemopoetic stem cell (HSC) transplant recipients from 2 weeks before until 12 months post transplant (or longer if GVHD)
  • Autologous HSC transplant (from prior to harvest until 6 months post transplant)
  • Hodgkin lymphoma (for life)
  • Aplastic anaemia patients
  • Patients receiving purine analogues (e.g., fludarabine, cladribine, etc.) indefinitely
  • Patients receiving some monoclonal antibody therapy (alemtuzumab but not rituximab, recommendations are not available for other monoclonal antibodies at this stage)
  • Patients receiving therapeutic antibodies against T cells e.g., ATG
  • HLA matched single donor platelets
  • Directed donations (Cellular components derived from near genetic relatives of the recipient) are not encouraged by NZBS however any directed donations that occur require irradiation.
  • Granulocyte transfusions

Possible other indications include:

  • Congenital cellular deficiency disorders (immunodeficiencies)
  • Premature/very low birth weight infants < 1500gm
  • Intrauterine transfusion and subsequent transfusion
  • Neonatal exchange transfusion
  • B and T cell malignancies
  • Acute leukaemia
  • Chronic myeloid leukaemia
  • Long term or high dose steroid recipients
  • High dose chemotherapy or radiotherapy resulting in lymphopenia less than 0.5 x 109/L

References

  1. NZBS transfusion medicine handbook 2008. A guide to the clinical use of blood components, blood products and blood transfusion procedures in New Zealand.
  2. Guidelines on the use of irradiated blood components 2010 www.bcshguidelines.com

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Document Control

  • Date last published: 24 May 2017
  • Document type: Clinical Guideline
  • Services responsible: National Child Cancer Network
  • Author(s): Tim Prestidge
  • Review frequency: 2 years