Irradiation Of Blood Products Research Articles

Transfusion-Associated Graft-Versus-Host Disease in Adults.

Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare but fatal complication of blood transfusion that usually develops two to 30 days following a blood transfusion giving rise to graft versus host disease (GVHD) clinical features that are consisting of fever, skin rash, jaundice, diarrhea, and pancytopenia. The disease is fulminant in most patients with a mortality rate of >90% of cases. The main aim of this review is to enhance awareness among medical practitioners about this fatal disease. Data were extracted manually from the main medical databases (Medline, Scopus, and Google Scholar) after the revision of selected articles and assessed for their contribution to the knowledge of TA-GVHD. TA-GVHD occurs when the viable donor T-cells in the blood or blood products attack the recipient's tissues which his/her immune system is incapable to destroy due to several reasons. The recipient's tissues that are usually involved in TA-GVHD include the liver, intestine, skin, lungs, and bone marrow. Any blood component either whole blood, packed red blood cells (RBCs), platelets, or fresh non-frozen plasma that contains viable T lymphocytes can cause TA-GVHD. Host immunodeficiency, transfusion of fresh blood, and partial human leukocyte antigen (HLA) matching between the donors and the recipients represent the major risk factors of TA-GVHD. Partial HLA matching includes immunocompetent recipients who receive blood from a first-degree relative also, seen in genetically homogenous populations because of high rates of consanguineous marriage. The diagnosis of TA-GVHD is mainly suspected based on clinical manifestations. However, a histopathological study of either skin or rectal biopsy is diagnostic. The treatment of TA-GVHD is generally not effective, unless the patient received emergency stem cell transplantation, while prevention via irradiation of blood or blood products represents the standard of care for this disease. In conclusion, medical practitioners should have a high index of suspicion for this disease. Moreover, future clinical trials targeting and comparing the outcomes of the different therapeutic options for TA-GVHD are required.

EVALUATION OF POSSIBLE COMPLICATIONS OF IRRADIATION OF BLOOD PRODUCTS ON PATIENTS

Background: Blood transfusion is a life-saving but high-risk procedure in various medical conditions as it is not a simple fluid infusion but an organ transplant. Although blood transfusions save lives, they may cause serious, life-threatening reactions. Nowadays, the number of reactions has decreased significantly with the reduction of leucocyte content of blood products or their irradiation. 
 Materials and Method: A total of 5582 patients who received irradiated blood products in our hospital between 14/08/2020 and 17/02/2023 were included in the present study. Erythrocyte suspension, platelet apheresis, and pooled platelet suspension were irradiated at doses of 25–30 Gy.
 Results: A total of 5582 blood products including 4990 erythrocyte suspensions, 282 pooled platelet suspensions, and 310 platelet apheresis were irradiated in the present study. No transfusion-associated Graft Versus Host Disease was identified in any patient included in the present study and there were only mild allergic reactions and febrile non-hemolytic transfusion reactions. 
 Conclusions: Based on the data obtained here from, it was concluded that irradiation of blood products can prevent the highly fatal transfusion-related Graft Versus Host Disease.

Conducting hematopoietic stem cell transplantation in low and middle income countries

ABSTRACT Background Hematopoietic stem cell transplantation (HSCT) is a well-recognized therapeutic procedure; costs limit its widespread use in low and middle income countries (LMIC). Methods Over a 30-year period, we have conducted HSCT in LMIC, making adaptations to the conventional procedures conducted in high-income countries (HIC). Results These salient observations stem from our practice: (1) Start with autologous transplantations in patients with hematological malignancies, specifically multiple myeloma; cell freezing devices are not necessary. (2) Next, consider auto-HSCT in patients with autoimmune diseases. (3) Introduce allogeneic transplants, initially using reduced intensity conditioning regimens. Conducting the HSCT on an outpatient basis is cheaper and safer. (4) Do not build HEPA-filtered rooms nor laminar flow cabins. (5) Do not graft cord blood cells nor start a cord blood blank. (6) Engage in haploidentical transplantations which are more feasible and cost-effective. (7) Matched unrelated donors are extremely expensive. (8) Use generic drugs and biosimilars. (9) Blood product irradiation devices are not necessary. (10) Do not try to reproduce other HSCT programs from HIC; develop your own methods. Conclusions HSCT can be conducted in LMIC with reduced costs and similar efficacy, thus making this therapeutic option affordable for more persons.

Use of X-rays to prevent transfusion-induced graft-versus-host disease

Transfusion associated graft versus host disease (TA-GvHD) is a rare complication of transfusion treatment with blood products containing viable lymphocytes. The risk of developing TA-GvHD depends on number and sustainability of lymphocytes in blood product, host’s immune system reactivity and the difference in human leukocyte antigen (HLA) system between donor and recipient. Standard method of TA-GvHD prevention is irradiation of blood products with ionizing radiation and absorbed dose of 25-50 Gy. The aim of irradiation is inactivation of viable lymphocytes in blood product containing cells (red blood cells, platelets, granulocytes) and lymphocyte proliferation inhibition in blood product recipient. In the last two decades, gamma irradiation has been extensively abandoned and replaced with specially designed cabinet machines using X-ray irradiation which are suitable for hospital and blood bank use. This reduces the risk of accidental or deliberate misuse of radioactive source, solves radioactive waste disposal issues and reduces ionizing irradiation exposure of employees in blood establishments. In Blood Bank of Croatian Institute of Transfusion Medicine, X-ray irradiation of blood products has been carried out since 2014 with a year rate of 20,000 irradiated cell blood products used in treatment of patients at risk of developing TA-GvHD.

Effects of hypoxic storage on the efficacy of gamma irradiation in abrogating lymphocyte proliferation and on the quality of gamma-irradiated red blood cells in additive solution 3.

Gamma irradiation of blood products is used to prevent transfusion-associated graft-versus-host disease by inhibiting the proliferation of lymphocytes that are implicated in the disease. Gamma irradiation also damages the red blood cells (RBCs). It is unknown whether hypoxia reduces the efficacy of gamma irradiation in inhibiting lymphocyte proliferation (LP). The objectives of the study were to investigate the effects of hypoxia on gamma irradiation-induced inhibition of LP and on the in vitro properties of RBCs. Forty-four units (300-340 ml each) of less than 8-h-old ABO-matched leukocyte reduced red cell concentrates (LR-RCC) in additive solution 3 were pooled in pairs. Peripheral blood mononuclear cells were isolated from non-leukocyte reduced RCCs and added back to the pool at a final concentration of 2 × 105 /ml. The pool was divided equally into a conventional storage bag A and a hypoxic processing and storage bag B. The units were gamma-irradiated at 25Gy on day 7 for the LP experiment and on either day 7 or 14 for the RBC quality experiments. LP was measured using a limiting dilution assay, and several in vitro metrics of RBCs were measured. Gamma irradiation inhibited T-lymphocyte proliferation by 4.7 × 104 -fold reduction in both hypoxic and conventional storage. The in vitro metrics of RBC quality were better preserved in hypoxic storage. T lymphocytes present in hypoxic RBC are equally susceptible to gamma irradiation as conventional storage. Hypoxic storage also reduces the deleterious effects of gamma irradiation on RBCs.

Impact of universal irradiation on chronic transfusion for sickle cell disease.

Irradiation of blood products prevents transfusion-associated graft-versus-host disease, but most patients do not require this modification which could have an adverse impact on transfusion outcomes. We hypothesized that irradiation may increase transfusion requirements for patients with sickle cell disease (SCD) receiving chronic transfusion. Our pediatric hospital implemented a new policy of universal blood product irradiation in May 2018. We conducted a retrospective chart review of patients with SCD receiving chronic red blood cell (RBC) transfusion throughout the year before and after institution of this policy. The primary outcome was the change in RBC transfusion volume per patient weight transfused during the pre- vs. post- universal irradiation period. Secondary outcomes were the change in median pretransfusion laboratory values. Among 17 patients, 8 (47%) received more RBCs the year before irradiation and 9 (53%) received more the year after irradiation. Implementation of universal irradiation did not significantly increase transfusion volumes needed to clinically manage this population (median change +1.7ml/kg/year, p= .54). Additionally, there were no significant changes in absolute reticulocyte count, hemoglobin, hemoglobin S%, white blood cell count, lactate dehydrogenase, total bilirubin, serum potassium, and ferritin during the two time periods. In a cohort of patients with SCD receiving simple chronic transfusion, irradiation did not impact transfusion requirements or pertinent pretransfusion laboratory values. Irradiation does not appear to have clinically significant consequences for SCD chronic transfusion management.

Developing a radiochromic dosimeter for dosimetry in blood irradiation chambers

Blood transfusion is known as a safe treatment, but it can sometimes be potentially dangerous. Despite careful examination, if the necessary precautions are not taken, blood transfusions can be unsafe for the recipient, and the risks can be fatal. Stable lymphocytes in blood products can cause fatal transplant reactions, and cause Transfusion-associated graft-versus-host disease, TA-GVHD. Prevention of this complication is possible only by direct irradiation of blood products before injection.In this study, a Fricke Xylenol Gel (FXG) dosimeter with the effective atomic number of 7.3 and density of 1.05 g/cm3 has been proposed for accurate blood irradiation dosimetry. This dosimeter is a radiochromic chemical tissue-equivalent dosimeter, which can be read out by spectrophotometry. In addition, a simple and rapid method has been proposed to determine the absorbed dose in the FXG dosimeter, using a negatoscope, and a camera. The results show that the dosimeter developed in this study can be used in the dose range required for blood dosimetry, 5–50 Gy. The dosimetry process can be performed with an uncertainty of less than 5%. The results show that this dosimeter has the acceptable properties to control the dosimetry quality of blood radiation for the prevention of transplant complications against the host.

Irradiating stored blood and storing irradiated blood: Is it different? - A study of serial changes in biochemical parameters of red blood cell units.

INTRODUCTION:Gamma Irradiation of blood products accentuates biochemical changes in the blood stored at 4°C. This study tried to compare the changes in potassium, sodium, glucose, lactate, and lactate dehydrogenase (LDH) levels in packed red blood cell (PRBC) units irradiated at various time points and then stored versus those stored for a particular period then irradiated.METHODOLOGY:One hundred and eighty units of RBCs were randomly assigned equally to be irradiated or not. Eighteen units each were irradiated by gamma irradiator using cobalt 60 (BI 2000) on day 1, 7, 14, 21, and 28 of their storage, respectively, in the irradiation group. All the units were assessed for their plasma levels of potassium, sodium, glucose, LDH, and lactate by clinical chemistry auto analyzer Beckman coulter AU680 weekly. The values were documented and analyzed by SPSS.RESULTS:Baseline values on day 1 for studied biochemical parameters were comparable between irradiated and nonirradiated groups. Mean values of potassium, lactate and LDH were higher in irradiated than nonirradiated PRBC bags. In contrast, Sodium and Glucose mean values were lower than baseline values. Maximum cumulative mean values were noted in day-21 irradiated bags when the parameters were measured on day-28 for potassium and lactate levels. This was followed by day 14 irradiated bags, followed by day 7 irradiated bags.CONCLUSION:The study indicates that irradiation of red cells later in their storage period had comparatively more detrimental changes in relation to potassium and lactate than irradiation in earlier days. Consideration of irradiation to be performed as close to the issue as possible to reduce a lesser number of days of storage postirradiation is to be explored.

Impact of Universal Irradiation on Chronic Transfusion for Sickle Cell Disease

Introduction: Irradiation of blood products is necessary to prevent transfusion-associated graft-versus-host disease (TA-GVHD) for patients at risk of this fatal transfusion complication. Despite the implementation of protocols to identify patients at risk of TA-GVHD, missed irradiation events still occur; therefore, some institutions have adopted a policy of universal irradiation of blood products to prioritize safety. Universal irradiation, however, could have an adverse impact on transfusion outcomes as red blood cell (RBC) unit irradiation has been associated with smaller hemoglobin (Hb) increments, biological changes to the RBC membrane, shortened RBC survival, and potassium release. These potential adverse effects of irradiation may be especially important for patients with sickle cell disease (SCD) receiving chronic transfusion, a group that does not require irradiated blood products. Methods: Our pediatric institution implemented a policy of universal blood product irradiation in May 2018 in which all RBC units are irradiated typically at time of issue. We conducted a retrospective chart review of patients with SCD receiving simple chronic RBC transfusion throughout the year before (5/3/2017-5/3/2018) and the year after (5/4/2018-5/4/2019) this policy change. Patients were excluded if during either time period they received fewer than 10 transfusions, chronic transfusion targets were modified, hydroxyurea was started, they received more than 5 RBC units for an acute complication, or they were transfused at an outside institution. The primary outcome was the change in RBC transfusion volume per patient weight transfused during the pre- vs. post- universal irradiation time period. Secondary outcomes were the change in median pretransfusion laboratory values. The change in these outcomes was analyzed with the Wilcoxon matched-pairs signed rank test. Results: Among 59 chronic transfusion patients, we identified 12 who fit our inclusion/exclusion criteria (5 males, 7 females), all of whom were on chronic transfusion for either primary or secondary stroke prevention. Regarding SCD genotype, 10 patients had Hb SS, and 1 patient had Hb Sβ0 thalassemia. The median patient age at the time of the irradiation policy change was 10 years (range 3 to 18 years). During the pre- universal irradiation time period only 4% (10/230) of units transfused to these patients were irradiated, likely due to reallocation from other patients. As expected per the policy change, 100% (271/271) of units were irradiated in the universal irradiation time period. During both time periods, patients received a median of 12 transfusions. When comparing the volume transfused per patient weight during these two time periods for each patient, 5 patients (42%) received more RBCs the year prior to universal irradiation and 7 (58%) received more RBCs in the year following the policy change (Figure). For the entire group, the median difference in volume per patient weight was +4.7 ml/kg, p=0.26. When comparing the change in median pretransfusion Hb, Hb S, lactate dehydrogenase, total bilirubin, potassium, and ferritin, there were no significant differences (Table). Conclusions: In a cohort of patients with SCD receiving simple chronic transfusion for stroke prevention, a new policy of universal irradiation did not impact transfusion requirements or pertinent pretransfusion laboratory values. Universal irradiation does not appear to have clinically significant consequences for SCD chronic transfusion management. Disclosures No relevant conflicts of interest to declare.

Double-filtered leukoreduction as a method for risk reduction of transfusion-associated graft-versus-host disease.

Transfusion-associated graft-versus-host disease (TA-GvHD) is caused by leukocytes, specifically T cells within a transfused blood product. Currently, the prevention of transfusion-associated graft-versus-host disease is performed by irradiation of blood products. With a sufficient reduction of leukocytes, the risk for TA-GvHD can be decreased. With consistent advances in current state-of-the-art blood filters, we herein propose that double filtration can sufficiently reduce leukocytes to reduce the risk for TA-GvHD. Thirty RBC concentrates were filtered with leukocyte filters, followed by storage at 1-6 oC for 72 hours, and then a second filtration was performed. Residual leukocytes in the double-filtered RBC units (n = 30) were assessed with flow cytometric methods, and an additional assay with isolated peripheral blood mononuclear cells (PBMCs) (n = 6) was done by both flow cytometric methods and an automated hematology analyzer. Quality of the RBCs after filtration was evaluated by hematological and biochemical tests. In vitro T cell expansion was performed using anti-CD3/CD28-coated Dynabeads or anti-CD3 (OKT3). In vivo experiment for GvHD was performed by using NOD.Cg-Prkdcscid Il2rgtm1Wjl/SzJ (NSG) mice. Double-filtered blood products showed residual leukocyte levels below detection limits, which calculated to be below 1200-2500 cells per blood unit. In vitro expansion rate of T cells showed that 6x103 and 1x103 cell-seeded specimens showed 60.8±10.6 fold and 10.2±9.7-fold expansion, respectively. Cell expansion was not sufficiently observed in wells planted with 1x102 or 10 cells. In vivo experiments showed that mice injected with 1x105 or more cells cause fatal GvHD. GvHD induced inflammation was observed in mice injected with 1x104 or more cells. No evidence of GvHD was found in mice injected with 103 cells. Our study suggests that additional removal of contaminating lymphocytes by a second leukodepletion step may further reduce the risk for TA-GvHD.

Improving Post-Transplant Outcomes Following Allogeneic Hematopoietic Stem Cell Transplant for Sickle Cell Disease in a Low Resource Setting: Experience from a Dedicated Post-Transplant Clinic in Nigeria

<h3>Background</h3> Allogeneic hematopoietic stem cell transplantation (Allo-HCT) is potentially curative in eligible patients with sickle cell disease (SCD). Improved transplant technology coupled with low transplant-related mortality has resulted in the development of a cottage industry in most of Africa, where 85% of all SCD births world-wide occurs. Families are seeking curative options primarily outside their country of residence, only to return back to a low-resource setting like Nigeria where long-term programs for the management of patient's post-transplant are lacking. <h3>Methods</h3> To address this perceived care gap, a dedicated post-transplant care clinic was developed. Patients were seen at various time points post-transplant (Days+112- 415). Most patients, (7/8), received haploidentical peripheral blood stem cell transplant from parental donors, while one patient received matched related bone marrow transplant. Three patients received myeloablative conditioning and five received non-myeloablative conditioning as well as preconditioning with hydroxyurea, azathioprine and chronic blood transfusion therapy. All patients who underwent haploidentical HCT received post-transplant Cytoxan as part of their GVHD prophylaxis. <h3>Result</h3> All patients had sickle cell anemia (HbSS), ages ranged from 2-18 years, all were considered asymptomatic (Figure 1). Main life-threatening health complications encountered include EBV reactivation in 38% (3/8), chronic GVHD 63% (5/8), others included febrile illnesses, pseudomembranous colitis, renal tubular acidosis, malnutrition and mixed chimerism (Figure 2). About 50% of the patients self-discontinued immunosuppression therapy without adequate guidance and most had delayed health maintenance measures such as routine immunizations and appropriate antimicrobial prophylaxis (Figure 3). Other logistical challenges encountered include delayed timely reporting of diagnostic tests (Chimerism: 14 to 21 days turnaround time; viral studies: 14 to 21 days turnaround time; drug trough levels: 14 to 21 days turnaround time), unavailability of irradiated blood products and lack of cost-effective medications. <h3>Conclusion</h3> A dedicated comprehensive, long-term care program for children with SCD residing in a low income setting who have undergone Allo-HCT, can improve their post-transplant outcomes. Locally adapted supportive care strategies can address the unique challenges encountered by these patients.

Transfusion-Associated Graft-Versus-Host Disease Confirmed by Human Leukocyte Antigen Typing in a Patient with Severe Combined Immunodeficiency and Review of the Literature

Background: Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare, but often lethal complication of cellular blood component transfusion that produces a graft-versus-host clinical manifestation in immunodeficient patients. We report a patient who developed TA-GVHD and provide a review of the literature. Method: We report an infant with severe combined immunodeficiency (SCID) who developed TA-GVHD. The patient received a nonirradiated, packed erythrocyte cell suspension and platelet transfusions from unrelated donors, before the diagnosis of SCID. The patient manifested symptoms and signs of TA-GVHD (fever, skin rash, diarrhea, icterus, eosinophilia and bone marrow failure) 3-weeks after blood product transfusions. Result: Immunology investigation was consistent with T– B– NK+ SCID. The recto-sigmoid biopsies confirmed the gold standard features of grade-II acute GVHD. HLA typing of the patient and his parents showed that the patient has an extra-parental-allele of major histocompatibility complex (MHC) class I B*53. He received high doses of methylprednisolone, IVIG and ursodeoxycholic acid, but he had progressive hyperbilirubinemia and bone marrow failure, then he developed candidemia and pseudomonas aeruginosa sepsis and multiorgan failure then he died. Discussion / Conclusion: SCID is one of several risks for TA-GVHD. TA-GVHD develops when transfused blood-derived immunocompetent, alloreactive T lymphocytes able to engraft in the recipient’s lymphoid tissues that fail to reject them. Those lymphocytes mediate immune response causing damage and dysfunction of the skin, gastrointestinal tract, liver and bone marrow failure. Our patient showed all features of TA-GVHD that was complicated by fulminant sepsis and multiorgan failure despite aggressive management. The diagnosis of this lethal condition needs high index of suspicion and the transfusion history must be questioned in all immunodeficiency patients. The disease is fulminate and rapidly fatal in majority of patients even with aggressive treatment, while irradiation of blood products that to be given to recipients at risk is the preventive method of choice.

Clinical Application of Blood Product Irradiation for Hematological Purpose-Review

Abstract With the development of transfusion medicine and the mastery of blood transfusion diagnosis and treatment techniques, the application of irradiated blood products in our country is gradually increasing. In recent years, the proportion of blood transfused by γ-rays has been increasing. In some foreign countries, the application rate of blood irradiated by radiotherapy is as high as 95%. At present, it is still in the promotion stage in China. This article summarizes the commonly used methods of blood irradiation, including the choice of irradiation source, the core dose and common irradiation targets, compares the difference of different irradiation methods, and generalizes the common application of blood irradiation. It is proposed that in addition to TA-GVHD application, blood irradiation may have a broad prospects for cancer therapy and microbial killing.

Clinical Application of Blood Product Irradiation for Hematological Purpose-Review

Abstract With the development of transfusion medicine and the mastery of blood transfusion diagnosis and treatment techniques, the application of irradiated blood products in our country is gradually increasing. In recent years, the proportion of blood transfused by γ-rays has been increasing. In some foreign countries, the application rate of blood irradiated by radiotherapy is as high as 95%. At present, it is still in the promotion stage in China. This article summarizes the commonly used methods of blood irradiation, including the choice of irradiation source, the core dose and common irradiation targets, compares the difference of different irradiation methods, and generalizes the common application of blood irradiation. It is proposed that in addition to TA-GVHD application, blood irradiation may have a broad prospects for cancer therapy and microbial killing.

2299 Resolution of Acute Cellular Rejection Using Irradiating Packed Red Blood Cells for Exchange Transfusion in a Patient With Sickle Cell Disease and a History of Orthotopic Liver Transplantation

INTRODUCTION: Liver transplantation in patients with Sickle Cell Disease (SCD) is fairly unique; a review article from 2013 noted only 15 reported cases within the literature. This case highlights a patient with SCD who underwent orthotopic liver transplantation. His course was complicated by iron overload due to recurrent exchange transfusions, as well as biopsy-proven acute cellular rejection (ACR), that was inadequately treated with corticosteroids, with no recurrence of rejection once the patient was switched to irradiated red cell exchange transfusions. CASE DESCRIPTION/METHODS: A 32-year-old male with HbSS disease, who had also undergone orthotopic liver transplantation at the age of 26 due to complications of Caroli’s disease presented with persistent abnormal liver tests over the course of several weeks. Graft function was normal during post-transplant until monthly exchange transfusions were initiated to manage his sickle cell crises. During this period he had two episodes of ACR and was noted to have persistent liver test abnormalities despite adequate therapeutic levels of tacrolimus. The patient was switched to receiving irradiated packed red blood cells for his subsequent exchange transfusions, which led to improvement of his liver tests and resolution of his acute cellular rejection. DISCUSSION: Only a limited number of patients with sickle cell disease have undergone liver transplantation, and this is the first case of using irradiated packed red cells for transfusion to help resolve acute cellular rejection. Although it is not thoroughly understood how blood transfusions could induce acute cellular rejection, it may be related to passenger donor leukocytes within the donor blood products triggering an immune response within the transplanted liver. Given our patient’s exposure to higher volumes of transfusions, there may have been enough donor lymphocytes to trigger this response. The use of irradiated blood products is common place in patients that have received hematopoietic stem cell transplants. Current recommendations do not standardize use of irradiated red cells for solid organ transplant (SOT) recipients. Our patient presents an unusual indication for use of irradiated red cells in a SOT patient.

The role of the HO-1/Heme axis on macrophage cytokine production

Abstract Transfusion Related Immunomodulation (TRIM) is a phenomenon that was first described over 30 years ago when it was reported that patients receiving blood transfusions prior to renal transplants had improved graft survival rates. The prevailing hypothesis for these observations at the time was that donor leukocytes were responsible for the effects; however, transfusion of leukoreduced and irradiated blood products still resulted in TRIM, suggesting that another component of the blood products, such as red blood cells (RBCs), might mediate the immunosuppressive effects. RBCs have been shown to affect the activation of immune cells and immune responses. For example, monocytes co-cultured with RBCs and stimulated with LPS produce lower levels of TNF-a than those that are not co-cultured. This suggests that RBCs can shape the immune response that develops during antigen presentation. Splenic red pulp macrophages are critical for clearance of both RBCs and heme, and these processes are essential for maintaining RBC homeostasis and preventing heme-mediated toxicity. Inside macrophages, heme is degraded by the enzyme Heme Oxygenase-1 (HO-1) and HO-1 activity leads to increased IL-10 and decreased TNF-a secretion. We hypothesized that erythrophagocytosis by macrophages during RBC transfusion may result in the activation of a heme-mediated HO-1 dependent signaling pathway that causes immunosuppressive effects. We used the robust TLR stimulation models of LPS and CpG challenge, and tested whether RBC transfusion or heme signaling could modulate the resulting macrophage cytokine response. We found that CORM-2 (a synthetic CO releasing molecule) downregulates the macrophage pro-inflammatory cytokine profile.

Using a radiation therapy LINAC as a backup system for providing irradiated blood products.

Using a radiation therapy LINAC as a backup system for providing irradiated blood products.

Transfusion-associated graft-versus-host disease: A concise review.

Transfusion-associated graft-versushost disease (TA-GVHD) represents a rare fatal event observed in immunocompromised patients and immunocompetent individuals. The main clinical features of this transfusion reaction are pancitopenia and multiorgan failure (skin, liver, gut). The possible pathogenesis includes donor T lymphocyte proliferation in blood, their engraftment and host tissue attack. The purpose of this narrative review was analyzing the international guidelines for irradiation of cellular blood components to prevent TA-GVHD. A literature search was conducted using PubMed articles published between January 2000 to July 2018. American, Australian, British and Japanese transfusion guidelines have been compared regarding clinical indications. The contribution of manuscripts has been focused on recipients of Haematopoietic Stem Cell Transplantation, severe cellular immunodeficient patients, fetuses and neonates, immunocompentent individuals. Furthermore, 348 cases of TA-GVHD in the last five decades have been documented according to a recent systematic review. The standard of care to prevent this complication is gamma or x irradiation of cellular blood products. New treatments with pathogen inactivation appear safe and effective against proliferating white blood cells and T cells. Further clinical and biological studies are necessary to better characterize immunocompetence of T cells and select alternative preventive strategies.

Transfusion practice in neonates.

Neonates, especially extremely low birth weight infants, are among the groups of patients undergoing transfusion frequently. Since they are exposed to higher specific transfusion risks compared to the patients of other age groups, there are many special aspects that must be considered for transfusion therapy in neonates. The transfusion risks in neonates include adverse outcomes specific for preterm infants as well as increased metabolic, immunologic, and infectious complications. To reduce the risks of transfusion-transmitted cytomegalovirus infection and transfusion-associated graft-versus-host disease, leukoreduced and irradiated cellular blood products should be used for all neonates. This review summarizes the risks of neonatal transfusion therapy, specific methods to reduce risk, and current trends and practices of red blood cell and platelet transfusions in neonates, to facilitate decision-making for neonatal transfusion.

Prevention of Transfusion-Associated Graft-Versus-Host Disease With Blood Product Irradiation: The Past, Present, and Future.

Transfusion-associated graft-versus-host disease (TA-GVHD) is a disease with a very high mortality rate. In this report, we discuss TA-GVHD from a historical perspective, highlight the pathogenesis of TA-GVHD, and emphasize the importance of blood product irradiation, which is a very effective means to prevent this disease. We summarize the current recommendations in different patient populations from different countries and review recent developments, such as alternatives for the use of radioactive materials. We also speculate on future directions.