Transfusion Efficacy of Apheresis Platelet Concentrates Irradiated at the Day of Transfusion Is Significantly Superior Compared to Platelets Irradiated in Advance

Abstract

Background: Gamma irradiation is currently the standard care to avoid transfusion-associated graft-versus-host disease. Guidelines on gamma irradiation of blood components state that platelets (PLTs) can be irradiated at any stage in their 5-day storage and can thereafter be stored up to their normal shelf life of 5 days after collection. In this study, we explored whether the timing of irradiation has an effect on transfusion efficacy of apheresis PLT concentrates (APCs). Methods: Based on the 1-hour percent PLT recovery (PPR_1h), transfusion efficacy of 1,000 eligible APCs transfused to 144 children were evaluated retrospectively. PPR_1h was compared in transfused APCs irradiated at the day of transfusion and APCs irradiated in advance. Results: In univariate analysis, transfusion efficacy of APCs irradiated in advance was significantly lower than that of APCs irradiated at the day of transfusion (mean PPR_1h 27.7 vs. 35.0%; p = 0.007). This was confirmed in multivariate analysis (p = 0.030). Compared to non-irradiated APCs, transfusion efficacy of APCs irradiated at the day of transfusion was not significantly inferior (mean difference -2.8%; 95% CI -6.1 to 0.5%; p = 0.092), but APCs irradiated in advance were clearly less efficient (mean difference -8.1%; 95% CI -12.2 to -4.0%; p < 0.001). Conclusion: Our data strongly support that APCs should not be irradiated in advance, i.e., ≥24 h before transfusion.

In vitro comparison between gamma‐irradiated cryopreserved and Day 7 liquid‐stored buffy coat–derived platelet components

“…Gamma irradiation of PLT components (25‐50 Gy) is routinely employed as part of the manufacturing process in an attempt to mitigate the risk of developing the highly lethal transfusion‐associated graft‐versus‐host disease (GVHD), caused by the engraftment of residual allogenic T‐lymphocytes remaining in PLT units . There is no effective clinical therapy once transfusion‐associated GVHD is initiated.…”

Prevention of transfusion‐associated graft‐versus‐host disease with pathogen‐reduced platelets with amotosalen and ultraviolet A light: a review

“…In 2014, the same group of authors reported a larger study, and they showed that γ‐irradiation of platelets was associated with a decrease in transfusion efficacy when compared with non‐irradiated platelets (mean PPR 32.7% vs. 39.3%; P = 0.014). However, this was due to irradiation of platelets in advance (≥24 h) (mean PPR 27.7%; P < 0.001), while the efficacy of irradiated platelets at the day of transfusion was not significantly inferior than that of non‐irradiated platelets (mean PPR 35.0%; P = 0.092) .…”

“…This recommendation by international guidelines is based on earlier transfusion studies where irradiation of platelets did not influence post‐transfusion platelet increments . However, three more recent studies showed decreased transfusion efficacy of irradiated platelets .…”

Hemovigilance

“…This may be due to the small size of the study, because they describe an observed difference of corrected count increment at 1 and 24 h in the order of 10% and also since the second paper looking at 1,000 platelet transfusions to 144 children strongly supports that apheresis platelet concentrates 'should not be irradiated in advance, i.e. 24 h before transfusion' [5]. Finally there is a report about the effects of the introduction of a guideline on red blood cell transfusion for elective orthopedic surgery.…”

“…They particularly describe an improved procurement with male FFP as prerequisite for the maximized implementation of their TRALI prevention strategy. Two further groups have focused on transfusion efficacy of gamma-irradiated platelet concentrates (PCs) [4,5]. The authors of the smaller but prospectively conducted study summarize that, within the two groups (2 × 20 transfusions / 40 patients), they found that 'hemostatic function, transfusion efficacy, bleeding, and safety of single-donor apheresis PCs treated with gamma irradiation versus untreated control PCs are comparable' [4].…”