Rebecca Cardigan, BSc, PhD; Sheila Maclennan , MBBS, FRCP, FrCPath

Disclosures

Transfusion Alter Transfusion Med. 2008;10(3):92-101. 

In This Article

Irradiation

Patients with congenital or acquired cellular immunodeficiency are at risk of development of TA-GVHD, an almost universally fatal condition caused by seeding of donor lymphocytes in the immunodeficient recipient. This condition can be prevented by irradiation of blood components prior to transfusion. A dose of 25-50 Gy is administered, usually using purpose-built gamma irradiation chambers; however, newer X-irradiation devices are now coming on the market, which do not carry the security risks of a gamma irradiation source.

Irradiation of red cells results in increase in extracellular potassium levels and hemolysis. For this reason, it is recommended that components only up to 14 days following collection are irradiated, and the shelf life is limited to 14 days post-irradiation. Potassium levels are more critical in neonatal transfusions, and therefore the shelf life of large volume transfusions for neonates (e.g. for exchange transfusion) is reduced to 24 hours post-irradiation. There is no change to the shelf life of platelets post-irradiation. Frozen components (FFP, cryoprecipitate) do not require irradiation as they do not contain live lymphocytes, and TA-GVHD has not been reported following transfusion of these components.

Patients at risk of TA-GVHD, who should receive irradiated cellular components, include hemopoietic stem-cell-transplant recipients, children with congenital cellular immunodeficiency, patients with Hodgkin's disease and those treated with purine analogue drugs and fetuses receiving intra-uterine transfusion (IUT). Subsequent transfusions to IUT recipients should also receive irradiated components during the neonatal period. Some immunocompetent patients are also at risk, namely those receiving HLA-matched platelets, transfusions from first- or second-degree relatives or therapeutic granulocytes.

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