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Product Profile : Irradiation

Transfusion-associated graft-versus-host disease (TA-GVHD) is a potential complication of the transfusion of any blood component containing viable T-lymphocytes. Under certain conditions these cells engraft and proliferate in the recipient. Cellular interaction between donor T lymphocytes and recipient cells leads to cellular damage (particularly the skin, thymus, gastro-intestinal tract, liver, spleen and bone marrow) leading to clinical consequences which are often fatal. The risks of TA-GVHD are highest in immune deficient or immune suppressed recipients; while in immunocompetent individuals, sharing an HLA haplotype with the donor is a major risk factor.

Gamma-irradiation is currently the only recommended method for the prevention of TA-GVHD and when indicated should be administered to all blood products containing significant numbers of white cells (whole blood, red cell concentrates and platelets).

Indications
  • All transfusions from blood relatives.
  • All HLA matched platelet concentrates.
  • Intra-uterine transfusion (IUT).
  • Exchange transfusion (ET) following IUT.
  • Recommended for all exchange transfusions provided this does not lead to undue delay of the ET.
  • Congenital immunodeficiency states (In some centres all blood for neonates is irradiated to avoid missing a congenital immunodeficiency)
  • All recipients of allogeneic bone marrow transplants (BMT) or peripheral blood stem cell transplants from the time of initiation of conditioning chemo/radiotherapy. This continues while patient is on GVHD. prophylaxis or lymphocytes > 1 x 109/L.
  • Patients undergoing stem cell harvesting for later autologous re-infusion.
  • All patients with Hodgkins Disease.
  • Patients treated with purine analogue drugs.
Blood may be irradiated at any time up to 14 days after collection and thereafter stored for a further 14 days after irradiation. Where there is a particular risk from hyperkalaemia (IUT, ET), it is recommended that red cells (usually whole blood in these cases) be transfused within 24 hours of irradiation. 		 

 
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