The use of irradiated components is to inactivate antigen-processing cells, which have been implicated in transfusion-associated graft versus host disease (TAGVHD). This condition is may be fatal and has been reported in a variety of clinical settings, both in immunocompromised and immunocompetent hosts.
Since we pathogen-inactivate platelet components, we are only irradiating RBC components. There is no need to irradiate any plasma components (e.g. FP24, thawed plasma, cryoprecipitate, or cryo-poor plasma.)
WARNING: Do not irradiate stem cell units!!
- Irradiation of packed RBCs will be given to the following patients:
- All candidates for stem cell transplantation SCT or patients post-SCT
- All severely immunosuppressed, excluding AIDS patients including:
- Congenital immunodeficiency states
- Intrauterine (i.e. fetal) transfusions
- Premature (less than 1500 grams or 28 weeks gestation) infant transfusions
- Neonatal Intensive Care Unit patients
- All hematopoietic tumors, including
- Hodgkin’s disease/lymphoma
- Non-Hodgkin’s lymphomas
- All acute leukemias
- Myelodysplastic states
- Myeloproliferative states
- Histiocytosis X, Langerhans histiocytosis
- Aplastic anemia
- All recipients of directed donations of any type, i.e. apheresis or components prepared from whole blood
- Recipients of HLA-selected platelets or platelets known to be HLA homozygous
- Irradiation Specification:
- Irradiate just prior to release if possible to minimize potassium leakage.
- Target 2500 cGy (rads) of gamma irradiation to the mid-plane of the canister of a free-standing irradiator is used or to the central mid-plane of the irradiation field if a radiotherapy instrument is used
- Using returned irradiated RBCs:
- If an irradiated unit is returned and otherwise meets re-release criteria, it may be used for up to 28 days after the irradiation or the normal outdate limit, whichever is less.
- For pediatric use (< 20 kg.), if the component was irradiated more than 24 hours previously, wash it prior to transfusion.
If you are uncertain whether to irradiate, ask the supervisor or the transfusion medicine physician.
- Standards for Blood Banks and Transfusion Services, Current Edition, American Association of Blood Banks, Bethesda, MD, USA.
- Guidelines to the Preparation, Use, and Quality Assurance of Blood Components, European Committee (Partial Agreement) on Blood Transfusion (CD-P-TS), Current Edition