Irradiation of Fresh Whole Blood for Prevention of Transfusion-Associated Graft-versus-Host Disease Does Not Impair Platelet Function and Clinical Hemostasis after Open Heart Surgery

Abstract

Since our previous studies suggested that the transfusion of 1 unit fresh whole blood (FWB) after cardiopulmonary bypass (CPB) using a bubble oxygenator may provide hemostatic benefit equivalent to 8-10 units of platelet concentrates, we have routinely used FWB at the termination of CPB. Two patients who received FWB and developed transfusion-associated graft-versus-host disease (TA-GVFID) prompted us to investigate the effect of irradiation of FWB on platelet and clinical hemostasis. Twenty-four patients were randomized to receive either 1 unit FWB (12 patients), or 1 unit irradiated FWB (IrFWB, 1,500 cGy, 12 patients) after CPB. Platelet aggregation on extracellular matrix, studied by a scanning electron microscope and graded from 1 to 4 (from poor to excellent aggregation), was similar in both groups preoperatively [3.3±0.9 (FWB) and 3.5 ±0.5 (Ir FWB)], and at the end of CPB [1.8±1.2 (FWB) and 1.9±0.9 (IrFWB)]. Platelet aggregation was similar after transfusion of FWB (3.0±1.0) and after IrFWB (3.2±0.8), as was the increase in platelet count. Twenty-four hours total postoperative bleeding was similar (560±420 and 523±236ml for FWB and IrFWB, respectively). We conclude that irradiation of FWB for prevention of TA-GVHD does not impair platelet aggregating capacity, and can be used when blood is donated by the patient’s next of kin.