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Transfusion associated graft versus host disease (TA-GvHD) is a rare and life threatening transfusion reaction that may occur in immunocompromised patients following the transfusion of cellular components. This complication can also occur in immunocompetent patients if HLA homology is present between recipient and donor. The outcome is nearly always fatal.
The use of irradiated components has been proven to reduce the incidence of TA-GvHD and is indicated in a number of clinical conditions.
This tool provides health professionals with guidance on situations when the use of irradiated cellular components is appropriate. This guidance may not be appropriate in all patient situations, and individual circumstances may dictate an alternative approach.
Patients should receive irradiated cellular components throughout entire disease management.
Patients should receive irradiated cellular components.
Duration for which patients require irradiated cellular components is not well defined.
Purine analogues which can cause immune suppression include fludarabine, deoxycoformycin (pentostatin), chlorodeoxyadenosine (cladribine), clofarabine and bendamustine.
Patients should receive irradiated cellular components during treatment and for a least 1 year following treatment.
Allogeneic HSCT should receive irradiated cellular components from time of initiation of conditioning chemotherapy/radiotherapy for minimum 12 months post-transplant.
Autologous HSCT should receive irradiated cellular components during & 7 days prior to bone marrow/stem cell harvest.
Also, must receive irradiated cellular components from time of initiation of conditioning chemotherapy/radiotherapy for minimum 3 months post-transplant.
Consideration should be given to transfusing irradiated cellular components to patients with B and T cell NHL.
Consideration should be given to transfusing irradiated cellular components.
Consideration should be given to transfusing irradiated cellular components.
Consideration should be given to transfusing irradiated cellular components.
No definitive recommendations can be made, therefore consideration should be given to transfusing irradiated cellular components to patients.
Refer to your local unit policy.
Routine use of irradiated cellular components is not indicated unless other risk factors are present including autologous HSCT and the use of nucleoside analogues.
No definitive recommendations can be made, but consideration should be given to patients with aplastic anaemia who are receiving immunosuppressive therapy.
Patients should receive irradiated cellular components.
Duration for which patients require irradiated cellular components is not well defined.
Purine analogues which can cause immune suppression include fludarabine, deoxycoformycin (pentostatin), chlorodeoxyadenosine (cladribine), clofarabine and bendamustine.
Patients should receive irradiated cellular components for a least 1 year following treatment.
Consideration should be given to transfusing irradiated cellular components.
Routine use of irradiated cellular components is not indicated unless other risk factors are present including autologous HSCT and the use of nucleoside analogues.
Consideration should be given to transfusing irradiated cellular components to patients with B and T cell NHL.
All platelets and red cells for intrauterine transfusion must be irradiated.
For exchange transfusions where there has been an intrauterine transfusion previously, irradiated cellular components are recommended.
Red cells transfused must be <5 days old and within 24 hours of irradiation.
Particular consideration should be given to providing irradiated cellular components for premature infants <28 weeks or <900 g.
Consideration should be given when possible.
Irradiation of cellular components is recommended for all infants/children with suspected or diagnosed T-cell immune deficiency states.
Directed donations should be irradiated.
Directed donations pose an increased risk of TA-GvHD due to possible shared HLA haplotypes within families.
Directed donations should be discouraged.
HLA matched platelets should be irradiated due to shared HLA haplotypes between recipient and donor.
There is conflicting evidence as to whether irradiation damages the granulocytes.
Granulocytes should be irradiated and must be transfused as soon as possible following irradiation.
Lymphocytes must not be irradiated.
The following congenital cellular immunodeficiency disorders should receive irradiated cellular components:
Not necessary to transfuse with irradiated cellular components.
Not necessary to transfuse with irradiated cellular components.
Not necessary to transfuse with irradiated cellular components.
Continued observation of new immunosuppressive regimes is required and guidelines updated in accordance with emerging data. Refer to individual institutional policy.
Not necessary to transfuse with irradiated cellular components.
Continued observation of new immunosuppressive regimes is required and guidelines updated in accordance with emerging data. Refer to individual institutional policy.
Not necessary to transfuse with irradiated cellular components.
Continued observation of new immunosuppressive regimes is required and guidelines updated in accordance with emerging data. Refer to individual institutional policy.
Not necessary to transfuse with irradiated cellular components.
Continued observation of new immunosuppressive regimes is required and guidelines updated in accordance with emerging data. Refer to individual institutional policy.
Not necessary to transfuse with irradiated cellular components.
Continued observation of new immunosuppressive regimes is required and guidelines updated in accordance with emerging data. Refer to individual institutional policy.
There is no recommendation regarding whether to transfuse with irradiated cellular components.
There is no recommendation regarding whether to transfuse with irradiated cellular components.
There is no recommendation regarding whether to transfuse with irradiated cellular components.
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