Dosing and uses of Irradiated blood and components
Prevention of Transfusion Associated Graft Versus Host Disease
Please see specific component monograph (i.e., RBCs, Platelets, Granulocytes, or Whole Blood) for dosing as there is no difference on dosing irradiated blood products from non-irradiated blood products.
Other Indications & Uses
Prevention of Transfusion Associated Graft Versus Host Disease (TA-GVHD) in cellular blood products given to
- Patients receiving products from first-degree relatives* or HLA-matched donors regardless of patient’s immune status
- Immunocompromised patients such as
- - Infants (particularly premature) up to 4, 6, or 12 months depending on institutional policy
- - Intrauterine transfusion* and/or neonatal exchange transfusion recipients
- - Congenital immunodeficiency disorders of cellular immunity (i.e., SCID, DiGeorge)*
- - Hematopoietic progenitor cell transplant recipients*
- - Hodgkin’s disease*, Leukemia, or Lymphoma patients
- - Patients treated with nucleoside analogs (i.e., fludarabine)
- - Patients requiring granulocyte transfusions*
- - Solid Organ Tumor patients undergoing intense chemotherapy (controversial and not universal)
- - Solid organ transplant recipient (controversial and not universal)
- - Aplastic anemia with severe lymphocytopenia (controversial and not universal)
- Irradiation of thawed plasma and cryoprecipitate are not necessary as they have never been associated with TA-GVHD. Fresh liquid plasma (never frozen) may have a small amount of viable lymphocytes and should be irradiated if the patient has indications for irradiated cellular blood products.
These are considered absolute indications for irradiation of cellular blood products. Many of the other indications listed are considered probable or controversial indications depending upon the linkage of TA-GVHD to these conditions. Utilization of irradiated products for these conditions should be based upon institutional policy as well as patient specific determinants.
Consult with your blood bank medical director for questions regarding indications of irradiated blood products
Pediatric dosage forms and strengths
Prevention of Transfusion Associated Graft Versus Host Disease
Please see specific component monograph (i.e., RBCs, Platelets, Granulocytes, or Whole Blood) for dosing as there is no difference on dosing irradiated blood products from non-irradiated blood products.
Irradiated blood and components adverse (side) effects
Frequency not defined
Hemolytic Transfusion Reactions
Febrile Non-Hemolytic Reactions
Allergic Reactions ranging from urticaria to anaphylaxis
Septic Reactions
Transfusion Related Acute Lung Injury (TRALI)
Circulatory Overload
Transfusion Associated Graft Versus Host Disease
Postransfusion Purpura
Warnings
Contraindications
Irradiation is contraindicated for hematopoietic progenitor cell and donor lymphocyte infusions as it will inhibit their ability to engraft and achieve their desired effects.
Irradiation is generally not indicated for patients with
- HIV
- Most solid tumors
- Routine immunosuppressive medications such as corticosteroids
- Isolated humoral immunodeficiency
- Hemoglobin disorders (i.e., sickle cell disease or thalassemia) that have not had a hematopoietic progenitor cell transplant
- Hemophilia
Cautions
The life span of irradiated RBCs is shortened (expires no greater than 28 days after irradiation) and potassium leakage from the red cells into the extracellular fluid occurs more rapidly with concentrations ranging from 55-100 mEq/L within a few days after irradiation. This may be dangerous for large volume/rapid infusions, or when infused close to the heart via central venous catheters particularly in infants and small children. Washing of stored irradiated RBC units may be indicated in these patients. Please see washed component monograph for more information on washing cellular components.
Additionally, the extracellular free hemoglobin concentration increases more rapidly during storage than in non-irradiated units.
There are no known significant alterations in platelet function with irradiation of 25 Gy.
All transfusions must be given via blood administration sets containing 170- to 260-micron filters or 20- to 40-micron microaggregate filters unless transfusion is given via a bedside leukocyte reduction filter. No other medications or fluids other than normal saline should be simultaneously given through the same line without prior consultation with the medical director of the blood bank.
Patient’s should be monitored for signs of a transfusion reaction including vitals pre, during, and post transfusion.
Please see specific component monograph for full safety information.
Consult with blood bank medical director or hematologist if you have questions regarding special transfusion requirements.
Pregnancy and lactation
Please see specific component monograph for pregnancy/lactation information.
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Irradiated blood and components
Please see specific component monograph.
Mechanism of action
Irradiation with 25 Gy renders lymphocytes incapable of proliferation, thus, preventing GVHD. Blood irradiators use either gamma or x-ray irradiation and there is no significant difference between which type of irradiator is used.
