Irradiated Blood Products (bsh 2010)

 

TA-GVHD

 

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

13 cases recorded by SHOT 1996 – 2001

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

  • Since the, 1400 cases of leukodepleted, but non-irradiated blood transfused to high risk patients —> No TA-GVHD

  • 2012 – neonate transfused with maternal blood (not leukodepleted) without irradiation, died TA-GVHD

Risk associated with an individual transfusion depends on:

  • Number and viability of lymphocytes

  • Immune status of recipient

  • Degree of HLA mismatch between donor and recipient

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

Clinical Features

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

  • Severe marrow hypoplasia

 

Irradiation Process

 

Red Cells:

  • Irradiate any time up to 14 days post collection

  • Can be stored for 14 days post-irradiation

  • 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

 

When 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