When to use irradiated blood products, such as Red Blood Cells (RBCs) and Platelets, to prevent Transfusion-Associated Graft-Versus-Host Disease (TA-GVHD)?

From the Guidelines

Irradiated blood products should be used for patients at risk of transfusion-associated graft-versus-host disease (TA-GVHD), including recipients of hematopoietic stem cell transplants, patients with hematologic malignancies undergoing intensive chemotherapy, and those receiving HLA-matched platelet transfusions or transfusions from blood relatives. These patients are at high risk of developing TA-GVHD, a rare but often fatal complication, and irradiation of blood products is the only reliable method to prevent it 1. The irradiation process involves exposing blood products to 25-50 Gy of gamma or X-ray radiation, which inactivates donor T-lymphocytes while preserving the therapeutic benefits of the transfusion.

Patient Groups at Risk

• Recipients of hematopoietic stem cell transplants
• Patients with hematologic malignancies undergoing intensive chemotherapy
• Patients receiving HLA-matched platelet transfusions or transfusions from blood relatives
• Patients with congenital immunodeficiency disorders
• Fetuses receiving intrauterine transfusions
• Low-birthweight premature infants

Irradiation Process

• Involves exposing blood products to 25-50 Gy of gamma or X-ray radiation
• Inactivates donor T-lymphocytes while preserving the therapeutic benefits of the transfusion
• Slightly reduces the shelf life of red blood cells (28 days instead of 35-42 days) and may increase potassium leakage, but does not significantly affect platelet or plasma function

Clinical Practice

• Irradiated products are clearly labeled and should be specifically requested when ordering blood for at-risk patients
• Leukoreduction alone is insufficient to prevent TA-GVHD, so proper irradiation remains essential for these vulnerable populations 1
• The decision to use irradiated blood products should be based on the individual patient's risk factors and clinical condition, and should be made in consultation with a hematologist or transfusion medicine specialist 1.

From the Research

Indications for Irradiated Blood Products

• Patients at highest risk for transfusion-associated graft-versus-host disease (TA-GVHD) include:
  • Premature infants 2
  • Immunocompromised patients due to congenital or acquired disease 2, 3, 4
  • Patients receiving immunosuppressive therapy 2
  • Immunocompetent patients who are heterozygous at a particular HLA locus and receive blood from a donor who is homozygous at the same locus 2
  • Neonates, infants, and children with congenital heart disease 3
  • Patients after bone marrow transplantation 5
  • Newborns and children in the 1st year 5
  • Patients with severe combined immunodeficiency 5
  • Patients receiving blood from first-degree relatives 5

Prevention of TA-GVHD

• Irradiation of cellular blood components is currently the only acceptable method for prevention of TA-GVHD 2, 3, 4, 5
• Blood products should be irradiated at least with 30 Gy just before transfusion 5
• The use of ultraviolet B light-irradiated blood products and leukoreduction filters are also being investigated as potential preventive treatment modalities 2