The contents and properties of packed red blood cells, the physiology of acute haemorrhage and the physiological responses to blood transfusion are detailed in other chapters.

Irradiated blood products arecomponents of whole blod which have been exposed to high doses of ionising radiaton, so as to cripple the lymphocytes they accidentally contain. The consequence of leaving the lymphocytes in situ is the dreaded transfusion-associated graft versus host disease (TA-GVHD), which (on top of the delightful gut and lung problems) also seems to cause massive bone marrow hypoplasia, and is associated with a 90% mortality.

Australia does not seem to have any specific circulated consensus publication about these products, but the British have issued a guideline statement in 2011. That said, the Australian Red Cross has a page where one can review the locally accepted indications for irradiated blood products. Their guidelines can be summarised and tabulated as follows:

Indications for Irradiated Blood Products
  • Immunocompromised patients, and specifically:
    • Lymphoma
    • Stem cell transplants
    • Aplastic anaemia
  • Immunocompetent patients receiving donated blood from relatives
  • Anyone receiving granulocyte transfusions
  • Anyone receiving HLA-matched platelets
  • Any neonates and any intrauterine transfusions

How much radiation to give? The NZBLOOD transfusion medicine handbook recommends a minimum dose of 25 Gy to the centre of the container. One should not exceed 50Gy, as one may harm useful blood components and end up with a damaged bag of packed cells.

References

Goodnough, Lawrence T., Jerrold H. Levy, and Michael F. Murphy. "Concepts of blood transfusion in adults." The Lancet 381.9880 (2013): 1845-1854.

Spahn, Donat R., and Lawrence T. Goodnough. "Alternatives to blood transfusion." The Lancet 381.9880 (2013): 1855-1865.

There is also a rescinded document from the NHMRC (2001) which has been used to guide practice: Clinical Practice Guidelines on the Use of Blood Components.

To some extent this document has been superceded by the Australian and New Zealand Society of Blood Transfusion GUIDELINES FOR THE ADMINISTRATION OF BLOOD PRODUCTS.

The Patient Blood Management Guidelines from the National Blood Authority of Australia is another series of documents worth looking at - it contains several important modules which have been reviewed and which act as successors to the 2001 NHMRC guidelines.

Treleaven, Jennie, et al. "Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force." British Journal of Haematology 152.1 (2011): 35-51.

Aoun, Elie, et al. "Transfusion‐associated GVHD: 10 years’ experience at the American University of Beirut—Medical Center." Transfusion 43.12 (2003): 1672-1676.

Heddle, Nancy M., and Morris A. Blajchman. "The leukodepletion of cellular blood products in the prevention of HLA-alloimmunization and refractoriness to allogeneic platelet transfusions [editorial]." Blood 85.3 (1995): 603-606.

Sharma, R. R., and Neelam Marwaha. "Leukoreduced blood components: Advantages and strategies for its implementation in developing countries."Asian journal of transfusion science 4.1 (2010): 3.

Dzik, Walter H. "Leukoreduction of blood components." Current opinion in hematology 9.6 (2002): 521-526.

Corwin, Howard L., and James P. AuBuchon. "Is leukoreduction of blood components for everyone?." JAMA 289.15 (2003): 1993-1995.

Blajchman, M. A. "The clinical benefits of the leukoreduction of blood products."Journal of Trauma-Injury, Infection, and Critical Care 60.6 (2006): S83-S90.

Rosenbaum, Lizabeth, et al. "The reintroduction of nonleukoreduced blood: would patients and clinicians agree?." Transfusion 51.12 (2011): 2739-2743.

Bilgin, Y. M., L. M. van de Watering, and A. Brand. "Clinical effects of leucoreduction of blood transfusions." Neth J Med 69.10 (2011): 441-450.

Australian Red Cross - Blood Service Policy on "The Age of Red Cells"

Hess, John R. "Red cell changes during storage.Transfusion and Apheresis Science 43.1 (2010): 51-59.

Bennett-Guerrero, Elliott, et al. "Evolution of adverse changes in stored RBCs."Proceedings of the National Academy of Sciences 104.43 (2007): 17063-17068.