How do we prevent transfusion‐associated graft‐versus‐host disease in children?

Abstract

The prevention of transfusion-associated graftversus-host disease (TA-GVHD) is critical for the reduction of transfusion-related risks. Because this complication of transfusion is difficult to treat and, consequently, has a high mortality rate, the optimal approach to management ofTA-GVHD is prevention. TA-GVHD is associated with the transfusion of cellular blood products (blood components that contain cells that retain the capability to engraft in a transfusion recipient), and prevention is most commonly achieved through gamma irradiation. Because prevention is critical, it is of the utmost importance to identify at-risk patients accurately. Although irradiation is quite effective at preventing TA-GVHD, there are suboptimal effects of irradiation on the red blood cell (RBC) membranes and increased costs that must be balanced. These factors lead to the adoption of selective protocols with only particular patients receiving irradiated blood products. We advocate less selective protocols and we highlight here our age-related policy for prevention of TA-GVHD in children with undiagnosed congenital immunodeficiency.