Radiated blood products

General
Radiation of blood products with at least 25 Gy is indicated when transfusion-associated Graft Versus Host Disease (TA-GVHD) must be prevented.
TA-GVHD is an infectious disease with a mostly fatal clinical course. It can arise after transfusion of blood products in which still live T-cells are present. The pathogenesis of TA-GVHD is still not (completely) known. The risk of the occurrence of TA-GVHD is largest after transfusion of cellular blood products to patients with a seriously impaired cellular immunity. However, TA-GVHD can also arise in immuno-competent recipients, if the donor of the cellular blood product is homozygous for one of the HLA haploids of a heterozygous recipient. TA-GHVD is characterised by fever, nausea, vomiting and diarrhoea, maculopapulous rash, elevated hepatic enzymes and bone marrow aplasia.
Leukocyte removal through filtration of cellular blood products is insufficient for preventing TA-GHVD.

Indications
The indications for radiation are:

hereditable serious immune deficiencies (Severe Combined Immuno Deficiency or SCID);
autologous and allogenic bone marrow/peripheral stem cell recipients as from 2 week before to up to and including 12 months after myelo-ablative therapy;
stem cell collection (peripheral blood/boon marrow) in the 6 weeks prior to after the collection;
donor lymphocyte infusion (DLI) as from 2 weeks before up to and including 12 months after the DLI;
treatment with purine analogues (fludarabine, cladribine, deoxycoformycin) up to and including 12 months after therapy;
patient with ATG-treatment to 6 months after therapy;
newborns with a birth weight < 1,500 g;
intra-uterine transfusion and also continuous transfusions until 6 months after the birth;
transfusion of a blood product of a first-degree, second-degree or third-degree relation;
HLA matched thrombocytes, even from un-related donors.
The indications cited in the literature, but not generally used in the Netherlands, are:
patients with Morbis Hodgkin, acute leukaemia, high-grade malignant lymphoma, solid tumour with intensive chemotherapy and obvious immuno deficiency;
organ transplant recipients.

Top

Erythrocyte products, radiated
Characteristics
Erythrocyte products can be radiated with at least 25 Gy. The erythrocyte membrane is damaged by the radiation and there is an accelerated release of potassium and haemoglobin during storage. The older the cell are at the moment of radiation, the worse is the damage. This will shorten the shelf life of the erythrocytes as follows:

radiated up to 14 days after extraction: store at 2 – 6 °C for a maximum of 28 days after extraction;
radiated more than 14 days after extraction: store at 2 – 6 °C for a maximum of 24 hours after extraction;
for intra-uterine administration or to newborns: store at 2 – 6 °C for a maximum of 6 or 24 hours, respectively, after extraction.

The remaining characteristics and storage conditions are not influenced by radiation.

Thrombocyte products, radiated
Thrombocytes can be radiated with at least 25 Gy. The remaining characteristics and storage conditions are not influenced by the radiation.

Top

« back