Blood and Tissue Resources

Guidelines For Irradiation of Blood and Blood Components

New York State Council on Human Blood and Transfusion Services
New York State Department of Health
Wadsworth Center
Empire State Plaza - P.O. Box 509
Albany, New York 12201-0509
Committee Members.

Guidelines (.pdf - 115KB)

Second Edition
2004

• Introduction
• Recommendations
• Requirements
• Pertinent Literature
• Committee Members

INTRODUCTION

1. Post-transfusion graft-vs-host disease (GVHD) is a serious risk for certain severely immunosuppressed or immunodeficient patients. Cellular components and fresh plasma for at-risk patients should be irradiated with a minimum of 2,500 cGy prior to transfusion. Medical evidence suggests that irradiation is not necessary for plasma components that have been frozen, such as fresh frozen plasma (FFP) and cryoprecipitate. GVHD has been reported in immunocompetent recipients who have received HLAmatched components or blood from an individual with a similar HLA haplotype, such as a close relative. Scientific evidence suggests that donor lymphocytes of similar HLA type are not perceived as foreign and therefore not destroyed by the recipient's immune system. Leukoreduction does not adequately reduce the risk of GVHD.
2. Acute transfusion-associated GVHD is caused by engrafted donor lymphocytes that produce an almost invariably fatal syndrome, usually including dermatitis, high fever, hepatitis, severe gastrointestinal symptoms, and panmarrow suppression -- however, all of these conditions may have various other causes in such patients. The symptoms arise within four to 30 days after transfusion, and death usually ensues within the first month after symptoms. The disease cannot be treated effectively. Occasionally, chronic GVHD may appear some 100 days after transfusion, producing a scleroderma-like syndrome.
3. Irradiation with 2,500-3,000 cGy has not been demonstrated to alter significantly the lifespan or function of platelets or polymorphonuclear leukocytes. Irradiation does reduce red blood cell (RBC) viability, and the expiration date for irradiated RBCs is the usual expiration date of the unit, or 28 days from the day of irradiation, whichever is earlier.
4. At present, no data are available to support the speculation that administration of irradiated blood components carries any immediate or long-term risks other than those associated with similar non-irradiated components.
5. Irradiated units are not radioactive and require no special handling.
6. Irradiated units may be used for patients other than the intended patient. There is no evidence that this practice is harmful.

RECOMMENDATIONS

Irradiation of blood components with a minimum of 2,500 cGy before transfusion is recommended for:

1. patients who have had or who may be having hematopoietic progenitor cell transplants, either allogeneic or autogeneic, including those with aplastic anemia, thalassemia, certain malignancies, and other conditions;
2. patients with congenital immunodeficiency syndromes;
3. fetuses receiving intrauterine transfusions;
4. infants receiving exchange transfusions or undergoing extracorporeal membrane oxygenation;
5. premature infants <1200g birthweight;
6. patients with Hodgkin's disease;
7. patients with leukemia or non-Hodgkin's lymphoma;
8. patients receiving HLA-matched components or blood from blood relatives. There may also be increased risk of GVHD for individuals transfused with blood from other members of a genetically related group; and
9. all granulocytes used for transfusion.

Irradiation of blood components may be considered for patients who have received a solid organ transplant and are considered to be immunosuppressed. Irradiation may be use-ful for other patients undergoing intensive chemotherapy or immunosuppressive therapy for oncologic or non-oncologic conditions.

Clinicians should notify their transfusion services or blood banks of any patients who should receive ONLY irradiated cellular blood components, so that patient records may be designated appropriately.

REQUIREMENTS

Equipment for irradiation of blood and blood components must be appropriately licensed and calibrated, with preventive maintenance measures documented as recommended by the manufacturer.

PERTINENT LITERATURE

1. Akahoshi M, Takanashi M, Yamashita H, et al. A case of transfusion-associated graft-versus-host disease not prevented by white cell-reduction filters. Transfusion 1992;32:169-72.
2. Anderson KC, Goodnough LT, Sayers M, et al. Variation in blood component irradiation practice: implications for prevention of transfusion-associated graft-versus-host disease. Blood 1991;77:2096-102.
3. Anderson KC, Weinstein HJ. Transfusion-associated graft-versus-host disease. N Engl J Med 1990;323:315-21.
4. Baglin TP, Marcus RE, Joysey V, et al. Graft-versus-host disease following blood product transfusion of solid organ transplantation. Brit J Haem 1991;77(Suppl):22.
5. Benson K, Marks AR, Marshall MJ, Goldstein JD. Fatal graft-versus-host disease associated with transfusions of HLA-matched, HLA-homozygous platelets from unrelated donors. Transfusion 1994;34:432-7.
6. Betzhold J, Hong R. Fatal graft-versus-host disease after a small leukocyte transfusion in a patient with lymphoma and varicella. Pediatrics 1978;62:63-6.
7. Brubaker DB. Human posttransfusion graft-versus-host disease. Vox Sang 1983; 45:401-20.
8. Capon SM, DePond WD, Tyan DB, et al. Transfusion-associated graft-versus-host disease in an immunocompetent patient. Ann Intern Med 1991;114:1025-6.
9. Davey RJ, McCoy NC, Yu M, et al. The effect of prestorage irradiation on posttransfusion red cell survival. Transfusion 1992;32:525-8.
10. Duguid JK, Carr R, Jenkins JA, et al. Clinical evaluation of the effects of storage time and irradiation on transfused platelets. Vox Sang 1991;60:151-4.
11. Funkhouser AW, Vogelsang G, Zehnbauer B, et al. Graft-versus-host disease after blood transfusions in a premature infant. Pediatrics 1991;87:247-50.
12. Hathaway WE, Brangle RW, Nelson TL, Roeckel IE. Aplastic anemia and alymphocytosis in an infant with hypogammaglobulinemia: graft-versus-host reaction? J Pediatrics 1966;68:713-22.
13. Hatley RM, Reynolds M, Paller AS, Chou P. Graft-versus-host disease following ECMO. J Pediatr Surg 1991;26:317-9.
14. Kanter MH. Transfusion-associated graft-versus-host disease: do transfusions from second-degree relatives pose a greater risk than those from first-degree relatives? Transfusion 1992;32:323-7.
15. Kruskall MS, Alper CA, Awdeh Z, et al. HLA-homozygous donors and transfusionassociated graft-versus-host disease. N Engl J Med 1990;322:1005-6.
16. Leitman SF, Tisdale JF, Bolan CD, et al. Transfusion associated GVHD after fludarabine therapy in a patient with systemic lupus erythematosus. Transfusion 2003;43:1667-71.
17. Linden JV, Pisciotto PT. Transfusion-associated graft-versus-host disease and blood irradiation. Transfus Med Rev 1992;6:116-23.
18. McMilin KD, Johnson RL. HLA homozygosity and the risk of related-donor transfusion- associated graft-versus-host disease. Transfus Med Rev 1993;7:37-41.
19. Moroff G, George VM, Siegl AM, et al. The influence of irradiation on stored platelets. Transfusion 1986;26:453-6.
20. Moroff G, Holme S, AuBuchon JP, et al. Viability and in vitro properties of AS-1 red cells after gamma irradiation. Transfusion 1999;39:128-34.
21. Otsuka S, Kunieda K, Hirose N, et al. Fatal erythroderma (suspected graft-versushost disease) after cholecystectomy: retrospective analysis. Transfusion 1989;29:544-8.
22. Rosen RC, Huestis DW, Corrigan JJ Jr. Acute leukemia and granulocyte transfusion: fatal graft-versus-host reaction following transfusion of cells obtained from normal donors. J Pediatr 1978;93:268-70.
23. Sakakibara T, Ida T, Mannouji E, et al. Post-transfusion graft-versus-host disease following open heart surgery: report of six cases. J Cardiovasc Surg 1989;30:687-91.
24. Thaler M, Shamiss A, Orgad S, et al. The role of blood from HLA-homozygous donors in fatal transfusion-associated graft-versus-host disease after open-heart surgery. N Engl J Med 1989;321:25-8.
25. Woods WG, Lubin BH. Fatal graft versus host disease following a blood transfusion in a child with neuroblastoma. Pediatrics 1981;67:217-21.

COMMITTEE MEMBERS

NEW YORK STATE
COUNCIL ON HUMAN BLOOD AND TRANSFUSION SERVICES

Membership Roster - 2004

NEW YORK STATE
COUNCIL ON HUMAN BLOOD AND TRANSFUSION SERVICES

BLOOD SERVICES COMMITTEE

Membership Roster - 2004

Requests for copies of this publication may be directed to:
Blood and Tissue Resources Program
New York State Department of Health
Wadsworth Center
Empire State Plaza
P.O. Box 509
Albany, New York 12201-0509
Telephone: (518) 485-5341
Fax: (518) 485-5342
E-mail: btraxess@health.state.ny.us.
Website:www.wadsworth.org/labcert/blood_tissue.