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Industrial Applications
Published in Vlado Valković, Low Energy Particle Accelerator-Based Technologies and Their Applications, 2022
A special case of sterilization is blood irradiation. Irradiating donated blood components before transfusion is the only accepted method to prevent transfusion-associated graft-versus-host-disease (TA-GVHD), an extremely dangerous blood complication with fatality rates reaching 90%. The difference in susceptibility to radiation between red cells and lymphocytes is the key for using X-ray and gamma ray treatments for blood products. A typical radiation dose required to deactivate harmful donor T-lymphocytes while leaving the other blood components is 15–50 Gy. High activity 137Cs sources are the primary method for blood irradiation in approximately 80% of American hospitals that irradiate blood.
Blood Groups, Blood Components and Alternatives to Transfusion
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Samah Alimam, Kate Pendry, Michael F. Murphy
Red blood cells are responsible for the transport of oxygen. Transfusion of RBC is indicated in massive haemorrhage, symptomatic anaemia, after chemotherapy and in chronic haematological conditions. ABO and RhD compatibility are essential for safe transfusion as described above. RBC are stored at 2–6 °C for up to 35 days. Irradiated blood, which is required for immunocompromised individuals at risk of transfusion-associated graft versus host disease (TA-GVHD), has a shorter shelf life of 14 days. It is important for the clinical team to inform the transfusion laboratory of this requirement. TA-GVHD is explained in more detail later in this chapter.
Transfusion support in transplantation
Published in Jennifer Duguid, Lawrence Tim Goodnough, Michael J. Desmond, Transfusion Medicine in Practice, 2020
Darrell J Triulzi, Ileana López-Plaza
Transfusion-associated graft-versus-host disease (TA-GvHD) results from the passive transfer of donor immunocompetent T cells capable of engrafting and initiating an immune response against the recipient.45–8 All HSCT recipients are presumed to be at risk for TA-GvHD because they may experience transplant-associated GvHD, even in the autologous setting.48–51 Like transplant-associated GvHD, the gastrointestinal tract, liver, and skin are involved, but to a more severe degree. The key feature that differentiates TA-GvHD from transplant-associated GvHD is a profound pancytopenia caused by the donor T-lymphocyte-derived destruction of the bone marrow. The TA-GvHD syndrome is characterized by high fever and an erythematous skin rash occurring 3–30 days after transfusion of a non-irradiated cellular blood component. This syndrome is typically refractory to all current therapies for transplant-associated GvHD and has an associated mortality rate of over 90%. The cellular blood components associated with this syndrome include red blood cells, platelets, and granulocytes. Plasma components such as fresh-frozen plasma, cryoprecipitate, and coagulation factor concentrates have not been associated with TA-GvHD. Because no successful treatment is currently available, the best option is to prevent the syndrome. TA-GvHD is prevented by gamma-irradiation52–55 of cellular blood components prior to transfusion for patients who are at risk. The function of the red blood cells,56,57 platelets,58–60 or granulocytes61 is not affected; however, the ability of red blood cells to tolerate storage is slightly decreased.62 Gamma-irradiated cellular blood products should be provided for all HSCT patients.
The platelets’ perspective to pathogen reduction technologies
Published in Platelets, 2018
Abdimajid Osman, Walter E. Hitzler, Patrick Provost
Transfusion-associated graft-versus-host disease (TA-GVHD) is another immunologic complication. It results from the presence of viable lymphocytes in the allograft which causes serious reactions in the host [36–40]. This complication can be prevented by exposing PCs to gamma irradiation (γ-irradiation), the method of choice under these circumstances. Gamma irradiation consists of high-energy, high frequency, electromagnetic waves of <10 picometers that causes a variety of DNA lesions [47]. Like X-rays, γ-radiation causes highly deleterious cellular alterations, including double-strand breaks and chromosomal rearrangements [48]. Other approaches such as utilizing filtration, centrifugation and washing may reduce the number of viable T-lymphocytes, but may not reduce the risk for TA-GVHD [49–51].
Current challenges in platelet transfusion
Published in Platelets, 2022
Peter Smethurst, Rebecca Cardigan
Transfusion-associated graft versus host disease (TA-GVHD) is rare but usually fatal complication of transfusion that is mitigated by leukodepletion, whilst irradiation of platelets (ɣ-or more recently X-) is an accepted method of prevention of TA-GVHD [45].
Hypoplastic thrombocytopenia and platelet transfusion: therapeutic goals
Published in Hospital Practice, 2019
Stamatis J. Karakatsanis, Stamatis S. Papadatos, Konstantinos N. Syrigos
PLTs, however, contain biologically active molecules which carry potential risks for their recipients [4]. PLT units deriving from whole blood units as well as those obtained by apheresis from a single donor unavoidably contain white blood cells (WBCs). The latter is responsible for febrile non-hemolytic transfusion reactions, alloimmunization and refractoriness to PLT transfusion, infections with intracellular pathogens and transfusion-associated graft-versus-host disease (ta-GVHD). Human platelet antigens (HPAs) can stimulate the production of alloantibodies and the latter may provoke post-transfusion purpura or lead to PLT transfusion refractoriness. PLT units also contain plasma proteins that have been linked to transfusion-related acute lung injury (TRALI – a rare event, but known to be one of the leading causes of transfusion-related death [5]) and allergic reactions [6]. Furthermore, they contain a small number of RBCs that express Rhesus (Rh) blood group antigens on their surface. These RBCs are significantly fewer in PLT units obtained by apheresis but, as a general rule, PLT transfusion from a Rh(+) donor to a Rh(-) woman of reproductive age should be avoided due to the possible risk of Rh alloimmunization and subsequent hemolytic disease of the newborn or else RhD negative females receiving RhD positive PLT units should receive RhD immunoglobin (100 IU intramuscularly for every 1 ml of transfused RBCs [7]) soon after the PLT transfusion (to prevent a possible hematoma) or within 72 hours at the most [8]. Moreover, PLT units are stored at room temperature which limits their storage time to 5–7 days only, due to the risk of bacterial overgrowth and consequent sepsis [9]. Globalization, on the other hand, contributes to the rising incidence of new pathogens, potentially transmitted through transfusions. Epidemiological studies have also shown that there may be a relationship between PLT transfusion and thrombosis, possibly due to the accumulation of low pH during their storage that ultimately leads to PLT and WBC activation [10,11]. Finally, patients who need PLT transfusions most often are those who suffer from hematologic malignancies or solid tumors, for example, patients that are fragile, immunocompromised, and with serious co-morbidities, prone to bleeding complications (Table 1) [12–14].