Irradiation and prolonged storage of red cells are associated with increased adverse events

Chen, J; Biller, Elizabeth; Losos, Michael; Li, J; Hamad, Diane; Blower, Luke; Grevenow, M; Oakley, Jee

doi:10.1111/vox.12660

Cited by 4 publications

(4 citation statements)

References 41 publications

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“…18 Red cell microparticles have been shown to activate both FXII and pre-kallikrein, and thus have pro-thrombotic and proinflammatory potential, 25,26 as well as activating platelets, increasing surface P-selectin and activating GPIIb/IIIa. 27,28 While these changes have not been linked to transfusion outcomes, a retrospective study found that gammairradiated RBCs were associated with more non-allergic transfusion reactions, and the frequency of non-allergic reactions increased with storage of irradiated RBCs, 29 suggesting that irradiated red cells may be more pro-inflammatory, and microparticles may potentially play a role in these reactions.…”

Section: Discussionmentioning

confidence: 99%

X‐ and gamma‐irradiation have similar effects on the in vitro quality of stored red cell components

et al. 2021

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Background: Blood components are irradiated to inactivate lymphocytes to prevent transfusion-associated graft versus host disease. As there are little data regarding the effects of X-irradiation on red blood cell components (RBCs), the in vitro quality of stored red cells (standard, pediatric, washed, and intrauterine transfusion [IUT]) following X-or gamma-irradiation was compared. Study design and methods: RBCs were pooled, split, and processed to produce standard (<14 days and < 5 days post-collection), pediatric (<5 days post-collection), washed (<14 days post-collection), or IUT RBCs (<5 days post-collection).Standard RBCs were either X-or gamma-irradiated (n = 10 pairs). A further 10 replicates were prepared by pooling and splitting three matched RBCs (X-, gamma-, and non-irradiated). All other RBCs were either X-or gamma-irradiated (n = 20 pairs). Red cell indices, hemolysis, potassium release, metabolism, microparticles, ATP, and 2,3-DPG were measured pre-irradiation and 6 h, 1, 2, 3, 7, 10, and 14 days post-irradiation, depending on the component type. Data were analyzed using two-way repeated measures ANOVA.Results: There were no significant differences in any in vitro quality measurements, with the exception of marginally higher potassium release in washed, IUT, and RBCs <5 days old (p < .0001) following X-irradiation.Both irradiation types increased generation of microvesicles, particularly in components that were older at the time of irradiation or stored for longer post-irradiation. Conclusion: X-and gamma-irradiation have similar effects on the in vitro quality of RBCs, indicating that either technology is suitable for blood component irradiation.

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Section: Discussionmentioning

confidence: 99%

X‐ and gamma‐irradiation have similar effects on the in vitro quality of stored red cell components

et al. 2021

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“…In a recently published retrospective study, 71 prolonged storage of irradiated red cells was associated with a significant increase in non‐allergic transfusion reactions. Overall, the irradiated red cells appeared to cause more non‐allergic reactions compared with non‐irradiated red cells with the leading type of reaction being febrile non‐haemolytic transfusion reaction.…”

Section: Manufacturing Aspects For Irradiated Componentsmentioning

confidence: 99%

Guidelines on the use of irradiated blood components

et al. 2020

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This guideline was compiled according to the British Society for Haematology (BSH) process at https://b-s-h.org.uk/med ia/16732/bsh-guidance-development-process-dec-5-18.pdf. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) nomenclature was used to evaluate levels of evidence and to assess the strength of recommendations. The GRADE criteria can be found at http:// www.gradeworkinggroup.org. Literature review details The last guideline covering this topic was published in 2012. Publications were searched systematically in English between 2008 and August 2019 covering the period since the last publication (Appendices 2 and 3). Review of the manuscript Review of the manuscript was performed by the BSH Guidelines Committee Transfusion Task Force, the BSH Guidelines Committee and the Transfusion and Malignant Haematology sounding board of BSH, and relevant specialists including paediatric cardiac anaesthetists and haematologists specialising in malignant diseases. It was also on the members section of the BSH website for comment. Purpose To provide healthcare professionals with clear guidance on situations when the use of irradiated blood components is indicated. The term 'blood component' means the therapeutic constituents of human blood (red cells, white cells, platelets and plasma) that can be prepared by various methods (JPAC https://www.transfusionguidelines.org/red-book/defini tions). The multidisciplinary writing group developed evidence-based clarification and practical guidance in clinical areas of ambiguity. Publications relating to patients of all age groups have been assessed. The guidance may not be appropriate in all patient situations and assessment of individual circumstances with the appropriate risk assessments and patient involvement may lead to alternative decisions.

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“…Table 1 displays several reports of TARs in pediatrics 1,3,5,6,13–24 . Mild ATR and FNHTR account for the majority of TARs, similar to the frequencies observed among adults 2,5,6,25,26 . Severe life‐threatening side effects such as anaphylactic shock, hypotensive reaction, TRALI, TACO, and other TARs have also been reported with some frequency 1–6,13 .…”

Section: Outline Of the Onset Of Transfusion‐associated Adverse React...mentioning

confidence: 68%

“…1,3,5,6,[13][14][15][16][17][18][19][20][21][22][23][24] Mild ATR and FNHTR account for the majority of TARs, similar to the frequencies observed among adults. 2,5,6,25,26 Severe life-threatening side effects such as anaphylactic shock, hypotensive reaction, TRALI, TACO, and other TARs have also been reported with some frequency. [1][2][3][4][5][6]13 Generally, TARs are likely caused by platelet (PLT) products that are particularly prone to cause mild ATR.…”

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Preventing adverse reactions in pediatric transfusions using washed platelet concentrate

Yanagisawa

2021

Pediatrics International

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Blood transfusion is an important form of supportive care in children; however, transfusion-associated adverse reactions (TARs) are a problem. As with adults, allergic transfusion reactions (ATRs) and febrile non-hemolytic transfusion reactions (FNHTRs) are major TARs, and the frequency of ATRs caused by platelet concentrate (PC) tends to be particularly high. The plasma component of the blood product is thought to be a major factor in the onset of TARs such as ATR and FNHTR. By contrast, in children, age, underlying disease, and number of blood transfusions may be relevant patient-related factors. Although acetaminophen or diphenhydramine may be used prophylactically to prevent TARs, there is no clear evidence of their effectiveness. Volume-reduced PC is used to prevent TARs; however, it may be difficult to maintain the quality of platelets. Plasma-replaced PC stored with platelet additive solution raises the concern that TARs cannot be completely prevented by residual plasma. Washed PC removes most of the plasma, so it can effectively prevent ATR and FNHTR. The recent development of platelet additive solution [M-sol, bicarbonate Ringer's solution supplemented with acid-citrate-dextrose formula A (BRS-A)] in Japan has enabled the maintenance of the quality of platelets for long periods. The clinical use of washed PC in Japan has therefore progressed. Washed PC with M-sol or BRS-A for pediatric patients can effectively prevent TARs without diminishing the transfusion effect. The supply of washed PC has begun from the Japanese Red Cross Society, and it has become possible to use washed PC at all medical institutions in Japan.

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Irradiation and prolonged storage of red cells are associated with increased adverse events

Abstract: Prolonged storage of irradiated RBCs was associated with a significant increase in non-allergic transfusion reactions. Overall, the irradiated RBCs appeared to cause more non-allergic reactions compared with non-irradiated RBCs.

Cited by 4 publications

References 41 publications

X‐ and gamma‐irradiation have similar effects on the in vitro quality of stored red cell components

X‐ and gamma‐irradiation have similar effects on the in vitro quality of stored red cell components

Guidelines on the use of irradiated blood components

Preventing adverse reactions in pediatric transfusions using washed platelet concentrate

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