From the Guidelines
Irradiated blood is the preferred choice for immunocompromised patients to prevent transfusion-associated graft-versus-host disease (TA-GVHD), whereas leukoreduced blood is used to reduce the risk of febrile non-hemolytic transfusion reactions, cytomegalovirus transmission, and alloimmunization to HLA antigens. The key differences between irradiated and leukoreduced blood are:
- Purpose: Irradiation prevents TA-GVHD; leukoreduction reduces various transfusion-related complications, as noted in the study by 1.
- Method: Irradiation uses radiation; leukoreduction uses filtration.
- Target: Irradiation inactivates white cells; leukoreduction removes them.
- Indications: Irradiation is for specific immunocompromised patients, such as those undergoing bone marrow transplants or certain cancer treatments, as highlighted in the study by 1; leukoreduction is more broadly applied. In practice, blood can be both irradiated and leukoreduced when necessary, providing maximum safety for certain high-risk patients, as suggested by the guidelines in 1 and the study by 1. The choice between these processes depends on the patient's specific medical condition and risk factors, with irradiation being crucial for patients with severely weakened immune systems, as emphasized in the study by 1. Some patients, such as recipients of autologous and allogeneic stem-cell transplants, or those receiving blood products from partially matched family members, are at greater risk of TA-GVHD and require irradiated blood, as noted in the study by 1. Overall, the decision to use irradiated or leukoreduced blood should be based on the individual patient's needs and risk factors, with the goal of minimizing the risk of transfusion-related complications and improving patient outcomes, as highlighted in the study by 1.
From the Research
Difference between Irradiated and Leukoreduced Blood
- Irradiated blood is treated with radiation to inactivate residual donor T lymphocytes, preventing transfusion-associated graft-vs-host disease (TA-GVHD) 2.
- Leukoreduced blood, on the other hand, has been filtered to remove white blood cells (WBCs), which can also help prevent TA-GVHD, as well as reduce the risk of other adverse reactions such as febrile nonhemolytic transfusion reactions and HLA alloimmunization 3, 4.
Effects of Irradiation on Blood
- Irradiation can have adverse effects on recipients and inventory management, and can cause changes in the metabolome of red blood cells, including increases in glycine, glutamine, and creatine 5.
- Higher doses of irradiation (35 and 50 Gray) can have significant effects on red blood cell mean corpuscular volume, hemolysis, and ammonia concentration after 7 and 14 days of storage 5.
Effects of Leukoreduction on Blood
- Leukoreduction can be achieved through filtration, which can remove WBCs to a level of 0.001% ± 0.003% cells/unit 2.
- Leukoreduced blood can be stored for up to 21 days or more without significant loss of viability or proliferative ability of residual WBCs 2.
- Subdivision of leukoreduced red blood cells does not have an appreciable influence on the storage of irradiated red blood cells in additive solution SAG-M 6.
Comparison of Irradiated and Leukoreduced Blood
- Both irradiated and leukoreduced blood can be used to prevent TA-GVHD, but leukoreduced blood may have fewer adverse effects on recipients and inventory management 2, 3.
- The choice between irradiated and leukoreduced blood may depend on the specific needs of the patient and the availability of blood products 3, 4.