Specialised Blood Products

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Cytomegalovirus (CMV)

Cytomegalovirus is a significant cause of mortality and morbidity in three main groups of immune-compromised patients:

  • Pregnant women
  • Neonates, especially children with immune deficiencies

Indication for CMV Negative Blood Products

  • Pregnant women
  • Neonates and children up to one year
  • Children with malignancies or immunodeficiencies having shared care with Our Lady’s Hospital, Crumlin
  • Intrauterine Transfusions
  • In exceptional circumstances, patients who have received Bone Marrow Transplant/ CAR T Cells may require CMV- products (at the discretion of a Consultant Haematologist or Consultant Paediatrician).

Irradiated Blood Products

TA-GvHD is a potential complication of transfusion of any blood component containing viable T lymphocytes when there is disparity in the histocompatibility antigens between donor and recipient. As well as the classical skin, gut and liver involvement seen in GvHD occurring after allogeneic stem cell transplantation, TA-GvHD is characterised by profound marrow hypoplasia and mortality in excess of 90%. There is a particular risk of TA-GvHD when the donor and patient share an HLA haplotype, as occurs within families or in populations with restricted haplotype diversity (BCSH, 2010)

 Irradiation of cellular blood products prevents donor lymphocyte proliferation thus preventing TA-GVHD.

There are increasing reports of TA-GVHD in patients receiving lymphotoxic chemotherapy, which has led to a widening of the indication for irradiated products. (BCSH, 2010)

Indications for Irradiated Blood Products

Paediatrics

  • Intrauterine transfusions and recipients thereof during the neonatal period
  • Exchange Transfusions – provided it does not cause undue delay
  • Congenital immunodeficiency states
  • All children with malignancies or immunodeficiencies having shared care with Our Lady’s Hospital, Crumlin

Stem cell transplant (SCT) and planned SCT recipients.

- Allogeneic transplants for 6 months after transplant or longer if ongoing GVHD
- Autologous transplants from 1 week pre harvest to 3 months post or 6 months if had TBI (Total Body Irradiation)

Haematological Malignancies

  • Hodgkin’s Lymphoma
  • Patients who have received Purine analogues or anti-T cell monoclonal antibody therapies e.g. Fludarabine, Cladribine, Deoxycoformincin, Campath, Pentospatin or Anti-lymphocyte globulin.
  • Patients who have receive Purine antagonists (similar activity to purine analogues) e.g. Bendamustine and Clofrabine
  • Patients who have received Anti-Lymphocyte monoclonal antibody therapy for CLL, Aplastic Anaemia or other haematological malignancies e.g. Anti-lymphocyte globulin, Alemtuzaman (campath-IH; antiCD52 therapy), Anti-thymocyte globulin (ATG)
  • HLA-matched platelets
  • Used in cases of platelet refractoriness
Note:

For special blood product requirements i.e. irradiated, washed, reconstituted or spilt products, the shelf life may be shortened. Contact the laboratory for further information

References:

- Practical Transfusion Medicine. Murphy and Pamphilon 2005 Blackwell Publishing
- Handbook of Transfusion Medicine 2001 HMSO
- BCSH Guidelines on the prevention of transfusion-transmitted CMV infection. Transfusion Medicine, 1999, 9, 115-123.
- 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,
   2011, 152(1), 35-51.