Guidelines for irradiation of blood and blood components to prevent post‐transfusion graft‐vs.‐host disease in Japan

Abstract

The Japanese Red Cross analysed the results of questionnaires sent in 1993 regarding post-transfusion graft-vs.-host disease (PT-GVHD) from hospitals; the majority of patients with PT-GVHD in 1993 were transfused for cardiovascular or cancer surgery, and about 10 patients had died yearly from PT-GVHD in the following few years. The Japan Society of Blood Transfusion (JSBT) organized a subcommittee for the prevention of PT-GVHD, and issued a fourth version of guidelines for the irradiation of blood to prevent PT-GVHD. These guidelines recommended transfusion of irradiated blood for cardiosurgery, cancer surgery, elderly recipients and severe trauma, as well as congenital immunodeficient recipients, newborn infants and other immunocompromised patients. Also recommended was irradiation not only of blood within 72 h after collection but also of blood stored for 14 days. Reported PT-GVHD has diminished to a few cases in recent years.

History of Blood Transfusion before 1990 Is a Risk Factor for Stroke and Cardiovascular Diseases: The Japan Collaborative Cohort Study (JACC Study)

“…Recently, allogeneic blood products for transfusion, such as RBC concentrates, platelet concentrates and plasma products, are usually used only after irradiation and leukocyte depletion by filtration [37]. Van de Watering et al [38] reported, in a large randomized controlled trial of patients undergoing cardiac surgery, that patients transfused leukocyte-depleted blood products by filtration before or after storage had fewer postoperative infections or mortality within 60 days after surgery than patients transfused standard packed cells.…”

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

“…During storage, potassium content in irradiated blood tends to increase more quickly compared with routine, nonirradiated products, and the amount of potassium is correlated with the radiation dose. 23,29 Potassium load could be an important limiting factor for rapid, large-volume transfusions (exchange transfusions, intrauterine transfusions, etc) and if there is preexisting hyperkalemia. 25 It was shown that reactive oxygen species are increased in irradiated blood components in a dose-dependent and storage timedependent manner.…”

“…16 In countries with a high risk of TA-GVHD, blood product irradiation recommendations include more clinical scenarios where the patient is immunocompetent, and there may even be practices to universally irradiate all red blood cells and platelets in such environments (eg, Japan). 29 …”

“…Several government agencies, such as the National Health Service in the United Kingdom, the Japan Society of Blood Transfusion in Japan, and the Istituto Superiore di Sanità in Italy, publish guidance documents with regular updates. 28,29,36 In contrast, the United States does not provide a national guideline for blood product irradiation, and this gap is filled by organizations such as the American Association of Blood Banks. 26 A 2014 survey conducted by the College of American Pathologists demonstrated that the 3 most common indications for blood product irradiation were ''transfusion from blood relatives'' (78.6%), ''HLA-matched or partially matched products'' (68.9%), and ''neonatal exchange transfusion'' (66.3%).…”

“…26 Application of this rule is different in some countries; for example, in Japan there is a 21-day shelf life rule, 29 and in the United Kingdom there is a 14-day shelf life rule 28 for the irradiated red blood cells. Platelet products do not need shelf life adjustments.…”