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

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

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 intra-uterine 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.

Preventing adverse reactions in pediatric transfusions using washed platelet concentrate

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.

Pediatric Hemovigilance and Adverse Transfusion Reactions

Some types of transfusion reactions occur more frequently in the pediatric than the adult population. Allergic reactions are the most common, followed by nonhemolytic transfusion reactions; male children seem most susceptible to such reactions. Platelets are often implicated and pulmonary reactions are understudied in children. Clinical sequelae in neonates, such as bronchopulmonary dysplasia/chronic lung disease and intraventricular hemorrhage, have received increasing attention in relation to transfusion. There is a need to better understand the pathophysiology of transfusion reactions in neonatal and pediatric populations so preventive strategies can be undertaken. There is also a need for robust hemovigilance systems.