Survey of Irradiation Practice for the Prevention of Transfusion-Associated Graft-versus-Host Disease

Abstract

Context.—Transfusion-associated graft-versus-host disease is a rare, often fatal complication of cellular blood product transfusion. The requirement that at-risk groups receive irradiated products reduces the incidence of transfusion-associated graft-versus-host disease. A comprehensive survey of irradiation practices has not been performed since 1989; meanwhile, new indications for irradiation have emerged. Objective.—To assess current irradiation practices at College of American Pathologists member institutions. Changes in irradiation practice indicated by comparing results of a survey of irradiation practices in 1989 with those of a survey performed in 2014 may reveal how the field has developed and what areas (if any) remain to be improved. Design.—A supplemental College of American Pathologists survey was sent out with questions regarding irradiation practices for specific conditions and circumstances. The questions included conditions for which irradiation is generally considered required for the prevention of transfusion-associated graft-versus-host disease as well as those not considered to be a special risk. Results.—An average of 2100 organizations responded to each question regarding their irradiation practices. Irradiation for transfusion from blood relatives, human leukocyte antigen–matched products, preterm infants, and Hodgkin disease were the most common indications cited. A few organizations had universal irradiation, whereas others irradiated products by floor/unit or by service. Conclusions.—For some at-risk populations irradiation of cellular blood products is more common than in 1989, whereas for others this practice has been reduced. Although gains have been made since the last national survey of irradiation practices, work remains to eliminate the possibility of transfusion-associated graft-versus-host disease from known at-risk populations.

Storage after gamma irradiation affects in vivo oxygen delivery capacity of transfused red blood cells in preterm infants

“…Gamma irradiation of RBCs is practiced widely across the world to protect the transfused immunocompromised patients from the potentially life‐threatening complication of transfusion‐associated GVHD . Recent in vitro studies have shown that the storage lesion is exacerbated by gamma irradiation and that it worsens during subsequent storage .…”

“…Preterm infants are intrinsically immunocompromised. Therefore, gamma irradiation of leukoreduced RBCs is used to prevent transfusion‐associated graft‐versus‐host disease (GVHD) . However, gamma irradiation also exacerbates “storage lesion” formation and accelerates biochemical, structural, and rheologic changes in stored RBCs …”

Transfusion‐associated graft‐versus‐host disease reexamined: potential for improved prevention using a universally applied intervention

“…42 A 2014 College of American Pathologists survey of practices at approximately 2100 US institutions revealed that 1) many institutions are not routinely irradiating units for immunocompromised patient groups known to be at risk for TA-GVHD (only 36%-63% performed irradiation across various at-risk disease categories), 2) immunocompetent patients routinely receive irradiated components only when the donor is known to be a blood relative, and 3) there is substantial interinstitutional variation. 97 A minority (2.6%) of institutions had more stringent policies including universal irradiation of all transfused cellular components or "block" irradiation for all patients on a given service/floor or for very young patients due to undiagnosed congenital immunodeficiency. Thus, the College of American Pathologists survey indicates that different US institutions implicitly tolerate different levels of risk for TA-GVHD.…”

Prevention of Transfusion-Associated Graft-Versus-Host Disease With Blood Product Irradiation: The Past, Present, and Future

“…There are variances in initiation and discontinuation of providing irradiated blood products to this patient population. 33 There is no evidence as to when irradiation may be safely discontinued in this patient population. 28 Transfusion service specialists (blood bank director, transfusion medicine consultant, etc) should be available for consultation.…”

“…26 A 2014 survey conducted by the College of American Pathologists demonstrated that the 3 most common indications for blood product irradiation were ''transfusion from blood relatives'' (78.6%), ''HLA-matched or partially matched products'' (68.9%), and ''neonatal exchange transfusion'' (66.3%). 33 These numbers are worrisome because general guidance requires universal irradiation (100%) for these indications, but depending on the scenario, 21.4% to 33 …”