Makindo Medical Notes

Irradiated blood products are used to prevent transfusion-associated graft-versus-host disease (TA-GVHD), a rare but often fatal condition where donor T-lymphocytes attack the recipient's tissues. Below are the common indications for irradiated blood:

Indications for Irradiated Blood Products

• Patients with Hodgkin's Lymphoma: These patients have a higher risk of transfusion-associated graft-versus-host disease (TA-GVHD) due to their immunosuppression.
• Bone Marrow or Stem Cell Transplant Recipients: Includes both autologous and allogeneic transplants, especially during conditioning and until immune recovery post-transplant.
• Granulocyte Transfusions: Donors and recipients require irradiated blood to minimize TA-GVHD risk due to the immunogenic nature of granulocytes.
• Severe Congenital Immunodeficiency Disorders: For example, severe combined immunodeficiency (SCID) or DiGeorge syndrome, where the immune system is compromised.
• Intrauterine Transfusions (IUT): Blood used for IUT must be irradiated due to the fetus’s immature immune system.
• Neonatal Exchange Transfusions: Irradiated blood is required for neonates during exchange transfusions to prevent TA-GVHD.
• Allogeneic Hematopoietic Stem Cell Transplant (HSCT) Recipients: This includes recipients of donor lymphocyte infusions (DLI) who need protection from TA-GVHD.
• Patients on Fludarabine and Purine Analogues: Drugs like cladribine or pentostatin increase the risk of TA-GVHD due to T-cell depletion.
• First-Degree Relative Donations: Blood from relatives requires irradiation due to the partial tissue compatibility, which poses a TA-GVHD risk.
• Post-Splenectomy Patients: Particularly those with underlying hematological conditions, as they are more susceptible to TA-GVHD.

Duration of Irradiation Requirement

• Allogeneic Transplant Patients: Require irradiated blood from the time of conditioning until at least 6 months post-transplant or until immune function is adequate.
• Autologous Transplant Patients: Typically need irradiated blood during conditioning and for 3 months post-transplant.
• Patients on Purine Analogues: Require irradiated blood for at least 6 months after completing therapy.
• Neonates: Should continue to receive irradiated blood until 6 months old if they had an intrauterine transfusion.

References

• NHS Blood and Transplant (NHSBT)
• British National Formulary (BNF)
• UK Transfusion Guidelines