Is pathogen reduction an acceptable alternative to irradiation for risk mitigation of transfusion-associated graft versus host disease?

Li, Marissa; Irsch, Johannes; Corash, Laurence; Benjamin, Richard J.

doi:10.1016/j.transci.2022.103404

Cited by 11 publications

(8 citation statements)

References 44 publications

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“…Thus, x-rays, which do not require a radioactive source, have attracted attention as a preferred alternative to gamma-rays. X-rays exert effects identical to those of gamma-rays in lymphocyte inactivation [13,28]. Our data show that a 30-Gy x-ray irradiation can trigger apoptosis of >90% of cells and induce negligible response to PMA stimulation (Figure S2), thus demonstrating the efficiency of x-rays in reducing alloreactivity.…”

Section: Bioluminescence Imaging Of Lymphocyte Biodistribution In The...mentioning

confidence: 55%

X‐ray irradiation effectively inactivated lymphocytes in transfusion in vivo monitored by the bioluminescence transfusion‐associated graft‐versus‐host disease model

Peng,

Bai,

Zhang

et al. 2024

Vox Sanguinis

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Background and ObjectivesTransfusion of cold‐stored whole blood is the preferred resuscitation method for trauma patients but may cause transfusion‐associated graft‐versus‐host disease (TA‐GVHD). Standard clinical practice to prevent this is to irradiate blood components with gamma‐rays. X‐ray irradiations are also a safe and effective alternative to gamma‐ray irradiation. We established a visual mouse model of TA‐GVHD to compare the viability and function of lymphocytes exposed to gamma‐ and x‐ray irradiation.Materials and MethodsA haploidentical transplantation mouse model was established to simulate TA‐GVHD with Balb/c mice as donors and hybrid F1 CB6 mice (Balb/c × C57) as recipients. Spleen cells from Tg‐Fluc+ Balb/c mice were isolated and irradiated with gamma‐rays and x‐rays. Lymphocyte activation, apoptosis and proliferation post phorbol 1 2‐myristate 1 3‐acetate (PMA) stimulation were evaluated. After transfusion, we monitored Fluc+ lymphocytes daily by bioluminescence imaging. Recipients were euthanized on day 21, and tissues were examined pathologically and for inflammatory cytokines.ResultsThe viability of gamma‐ or x‐ray irradiated lymphocytes decreased significantly with slight changes in proliferation in vivo after transfusion. Compared with the non‐irradiated group, both the gamma‐ and x‐ray irradiated groups showed significantly decreased clinical scoring and inflammatory cytokine levels. The fluorescence intensity of the body and target organs was reduced after irradiation.ConclusionNo recipients acquired TA‐GVHD after lymphocyte transfusion subjected to gamma‐ or x‐rays, showing that x‐rays inactivate as well as gamma rays and are suitable for irradiating whole blood.

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Section: Bioluminescence Imaging Of Lymphocyte Biodistribution In The...mentioning

confidence: 55%

X‐ray irradiation effectively inactivated lymphocytes in transfusion in vivo monitored by the bioluminescence transfusion‐associated graft‐versus‐host disease model

Peng,

Bai,

Zhang

et al. 2024

Vox Sanguinis

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“…Their appeal thus stems in part from their potential to safeguard the blood supply against new infections. Another benefit of PRTs is the inactivation of passenger leukocytes, which raises the possibility that PRTs may eventually replace irradiation to prevent transfusion-associated graft-versus-host disease (TA-GvHD) [50].…”

Section: Pathogen Reduction Technologiesmentioning

confidence: 99%

“…According to a modelling study in Uganda, PRT combined with rapid diagnostic tests may be superior to serological testing (alone) to reduce the incidence of HIV, HBV, HCV and malaria [87]. Moreover, PRTs inactivate passenger leukocytes and may thus be particularly effective at reducing the incidence of TA‐GvHD in LMICs [50], where non‐leukoreduced whole‐blood components are commonly transfused. Clearly, more cost‐effectiveness analyses are needed to assess the costs and benefits of PRT in LMICs.…”

Section: Outlook For Low‐income and Middle‐income Countriesmentioning

confidence: 99%

The future of blood services amid a tight balance between the supply and demand of blood products: Perspectives from the ISBT Young Professional Council

Lewin,

McGowan,

Ou‐Yang

et al. 2024

Vox Sanguinis

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Background and ObjectivesBlood services manage the increasingly tight balance between the supply and demand of blood products, and their role in health research is expanding. This review explores the themes that may define the future of blood banking.Materials and MethodsWe reviewed the PubMed database for articles on emerging/new blood‐derived products and the utilization of blood donors in health research.ResultsIn high‐income countries (HICs), blood services may consider offering these products: whole blood, cold‐stored platelets, synthetic blood components, convalescent plasma, lyophilized plasma and cryopreserved/lyophilized platelets. Many low‐ and middle‐income countries (LMICs) aim to establish a pool of volunteer, non‐remunerated blood donors and wean themselves off family replacement donors; and many HICs are relaxing the deferral criteria targeting racial and sexual minorities. Blood services in HICs could achieve plasma self‐sufficiency by building plasma‐dedicated centres, in collaboration with the private sector. Lastly, blood services should expand their involvement in health research by establishing donor cohorts, conducting serosurveys, studying non‐infectious diseases and participating in clinical trials.ConclusionThis article provides a vision of the future for blood services. The introduction of some of these changes will be slower in LMICs, where addressing key operational challenges will likely be prioritized.

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“…A happy side effect is the inhibition of leukocyte division, eliminating the need to irradiate if irradiation was indicated. 93 Although pathogen reduction is effective for its stated purpose, it adds around $125 to the cost of every unit, 1 reduces the average posttransfusion platelet count boost from 30,000 to 20,000 cells/mm -3 , and increases transfusion requirements. 94 In 2020, the Food and Drug Administration (Silver Spring, Maryland) released new guidance for blood centers requiring either more sensitive bacterial testing for platelet units, or adoption of pathogen reduction.…”

Section: Modifications To Stored Bloodmentioning

confidence: 99%

What’s in Your Transfusion? A Bedside Guide to Blood Products and Their Preparation

Hess

2023

Anesthesiology

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A general understanding of blood products and their modifications will help any physician make good decisions about transfusion. The separation of blood into products makes the fullest use of every donation: it maximizes the lifespan of each component, allows us to treat specific hematologic deficits, and offers the benefit of one donation to many patients. Every product is also modified in some way to prevent clotting, extend shelf life, improve efficacy, or reduce the risk of adverse events. Every one of these steps has been developed with patient benefit in mind, but they still have consequences that anesthesiologists have to be aware of. In some cases, these consequences have provoked complex responses: the development of Massive Transfusion Protocols and balanced "1:1:1" transfusions was essentially a scientific, clinical, and administrative effort to undo the inadvertent harms of separating whole blood into red cells, plasma, and platelets. With a limited blood supply and competing clinical requirements, understanding what you are actually transfusing is essential.In this narrative review, I will discuss the five basic blood products and five common modifications. Each product or modification is presented within a short clinical vignette; details are supplied in the figures and tables. I have also included a brief section on important transfusion reactions and their management. Finally, there is a list of additional resources for the interested reader. Blood ProductsOur blood supply in the United States comes from around 8 million donors who give between 1 and 20 times each year. 1 Although approximately 14 million products are collected every year, there are less than 2 weeks' supply of red cells and plasma in the U.S. inventory, and sometimes less than a day's supply of platelets. 2 Forty percent of the U.S. blood supply is collected by the American Red Cross (Washington, D.C.), with most of the rest collected by other independent institutions like Blood Bank of Hawaii (Honolulu, Hawaii) or OneBlood (St. Petersburg, Florida). 1,2 These blood centers are responsible for screening donors, collecting blood, separating them as necessary, labeling blood so it can be shipped in interstate commerce if the center is so licensed, and maintaining records (fig. 1). [3][4][5][6][7] Hospitals and clinics pay blood collectors for their products to cover the costs of materials, testing, and labor, with the specific price dependent on the unit and local contracts. There are also many for-profit blood centers that collect plasma and cells for the commercial preparations of albumin, immunoglobins, biologic therapies, and other reagents. Donors to commercial centers are usually paid to donate, but almost all blood collected for clinical transfusion in the United States comes from unpaid volunteers. 9 Low-titer Group O Whole BloodA 23-yr-old woman is hurt in a car crash. At the scene she has bilateral thigh deformities, tachycardia, hypotension, and altered consciousness. In the helicopter ride to the trauma center, she rece...

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Is pathogen reduction an acceptable alternative to irradiation for risk mitigation of transfusion-associated graft versus host disease?

Cited by 11 publications

References 44 publications

X‐ray irradiation effectively inactivated lymphocytes in transfusion in vivo monitored by the bioluminescence transfusion‐associated graft‐versus‐host disease model

X‐ray irradiation effectively inactivated lymphocytes in transfusion in vivo monitored by the bioluminescence transfusion‐associated graft‐versus‐host disease model

The future of blood services amid a tight balance between the supply and demand of blood products: Perspectives from the ISBT Young Professional Council

What’s in Your Transfusion? A Bedside Guide to Blood Products and Their Preparation

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