Irradiated Blood Products (2010)

 

TA-GVHD

 

-       Very rare but >90% fatal complication following transfusion of lymphocyte-containing blood components.

-       13 cases recorded by SHOT 1996 – 2001

o   Leukodepletion appears to have near-eliminated risk of TA-GVHD

o   405 cases of non-irradiated blood transfused to high risk patients à No TA-GVHD

o   2012 – neonate transfused with maternal blood without irradiation, died TA-GVHD

-       Risk associated with an individual transfusion depends on:

o   Number and viability of lymphocytes

o   Immune status of recipient

o   Degree of HLA mismatch between donor and recipient

§  E.g. Risk is 10-20x higher in Japanese due to restricted haplotype diversity

-       Clinical Features

o   Skin, gut, liver as per other causes of GVHD

o   Severe marrow hypoplasia

 

Irradiation Process

 

-       Red Cells:

o   Irradiate any time up to 14 days post collection

o   Can be stored for 14 days post-irradiation

o   Use within 24 hours if pt at risk of hyperkalaemia (IUT / neonatal)

-       Gamma or X-irradiation, minimum dose 25Gy – maximum 50Gy

-       Not necessary to irradiate FFP, cryoprecipitate, fractionated plasma products or frozen red cells

 

Indications for Irradiation, for ALL:

 

-       Donations from first or second-degree relatives, even if pt is immunocompetent

-       HLA-selected components, even if pt is immunocompetent

-       Granulocyte components

-       Intra-uterine transfusion

-       Transfusion where there has been previous IUT, until 6 months post EDD

-       Severe T lymphocyte immunodeficiency syndromes

-       Recipients of Allografts, from the time of starting conditioning chemotherapy until minimum of 6 months post. Life-long if chronic GVHD.

-       Stem cell donors (including autologous) for 7 days prior to, and during, harvest

-       Autograft patients, from time of starting conditioning until 3 months post-transplant    (6 months if TBI used)

-       Hodgkin Lymphoma for life

-       Purine analogues / antagonists for life

-       Alemtuzumab recipients for life

-       ATG recipients for undefined length of time

 

-       Recommended for other neonatal exchange transfusion, provided it does not delay Tx

 

Who to report to SHOT

 

-       All cases of TA-GVHD

-       Any non-irradiated products transfused to high risk patients

 

Ensuring irradiated requirements are met:

 

-       Patient education

-       Patient alert card

-       Laboratory Flags

-       IT links between pharmacy and laboratory