CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Survey of irradiation practice for prevention of transfusion-associated graft-versus-host disease
Transfusion-associated graft-versus-host disease is a preventable, uncommon, and highly fatal complication of cellular blood product transfusions. In cases of TA-GVHD, viable donor lymphocytes from blood products replicate and attack the recipient, who is unable to mount a sufficient immune response. Irradiated products prevent TA-GVHD in high-risk groups. The authors conducted a study to assess the current irradiation practices at College of American Pathologists member institutions by comparing the results of a 2014 CAP Survey of irradiation practices to a comprehensive 1989 American Association of Blood Banks survey of such practices. The latter was the last time a comprehensive review of irradiation practices was performed, despite the emergence of new indications for irradiation. The intent of the study reported herein was to determine how the field has developed and what, if any, areas need to be improved. The authors reported that an average of 2,100 organizations responded to each question in the 2014 CAP Survey regarding irradiation practices for specific conditions and circumstances. The most commonly reported indications for irradiation were for transfusion from blood relatives, human leukocyte antigen-matched products, preterm infants, and Hodgkin disease. A few organizations performed universal irradiation on all cellular blood products, and others irradiated by floor/unit or by service. Unexpectedly, fewer organizations required irradiation for some at-risk groups, including those with congenital immunodeficiency syndrome, Hodgkin disease, acute leukemia, and lymphoma, than in the 1989 assessment. The authors also noted a slight decrease for a few groups not considered to be at risk, such as HIV/AIDS patients. The study concluded that irradiation practices continue to be widely disparate across institutions. This may be, at least in part, a result of the United States not providing national guidelines on the use of irradiated components, thereby leaving decisions regarding indications for irradiation to individual institutions. The authors suggest that work still remains to eliminate the risk of TA-GVHD in at-risk populations.
Pritchard AE, Shaz BH. Survey of irradiation practice for the prevention of transfusion-associated graft-versus-host disease. Arch Pathol Lab Med. 2016;140:1092–1097.
Correspondence: Dr. Beth H. Shaz at bshaz@nybc.org