In this section
TA-GVHD is a rare but usually fatal complication of transfusion.
The disease occurs when donor lymphocytes engraft in a susceptible
recipient. These donor lymphocytes proliferate and damage target
organs, especially bone marrow, skin, liver and gastrointestinal
tract. Typically the condition presents 10-14 days after
transfusion with rash (erythroderma), pancytopenia and abnormal
liver function. There is a longer time between transfusion and
presentation in neonates. The mortality rate of TA-GVHD approaches
The risk with an individual transfusion depends on a number of
factors including, the viability of contaminating lymphocytes in
the blood product, the susceptibility of the recipient's immune
system to their engraftment, and the degree of immunologic
disparity between the donor and recipient.
TA-GVHD was originally recognised as a complication of intrauterine
transfusion and transfusion to recipients of allogeneic bone marrow
transplants. The most commonly reported setting for TA-GVHD is
immunocompetent recipients of blood from biologically related
(directed) or HLA identical donors.
The main stay of preventing TA-GVHD is gamma irradiation of
blood products. Leukocyte depletion using current technology is
inadequate for this purpose.
Irradiation of blood products is undertaken using a dedicated
blood irradiator with a long half-life gamma emitting source.
Irradiation of red blood cells and whole blood
results in reduced post transfusion red cell recovery and increases
the rate of efflux of intracellular potassium. It has no clinically
significant effect on red cell pH, glucose, 2,3 DPG levels or ATP.
Packs irradiated within 14 days of collection expire 28 days after
collection. Packs irradiated more than 14 days after
collection expire either 5 days after irradiation OR at original
expiry of pack, whichever comes first. In patients where
hyperkalaemia is a concern, red cells should be transfused within
24 hours of irradiation. Examples include large volume neonatal
transfusion such as exchange transfusion, ECMO or rapid large
Irradiation of platelets has not been shown to
cause any clinically significant change in platelet function.
Platelets may be irradiated at any stage during their 5 day storage
life. In Victoria all platelets are irradiated by ARCBS prior to
Irradiation of granulocytes. There is
conflicting evidence of irradiation damage to granulocytes.
Granulocytes should be transfused as soon as possible after
collection and irradiation.
Blood product irradiation is identified using the Radsure™
system. A label is applied to the blood pack prior to irradiation.
The words NOT IRRADIATED are visible. Once
irradiation has taken place, the word IRRADIATED
The clinician requesting the crossmatch or blood product is
responsible for ensuring irradiated components are requested for
appropriate patients. Tick the box on the request form indicating
irradiated products are required.
During the final bedside check prior to blood product
administration, a check is made to ensure that appropriate blood
product modifications such as irradiation or leukocyte depletion
have been performed when requested by the treating clinician.
RCH blood bank has an onsite blood irradiator with a capacity
for a single unit of red blood cells or whole blood and an
irradiation time of 4 minutes 30 seconds. Red cell products are
irradiated at the time of crossmatch or just prior to release for
neonatal, intensive care and cardiac surgery patients.
At RCH a universal blood irradiation policy applies for patients
in the following units: ICU, NNU, Haematology/Oncology. Although
not all patients in these units are at risk of TA-GVHD, this policy
ensures patients who require irradiated products are not
(Note - stem cells and bone marrow must not be irradiated).
In addition blood is irradiated at RCH in the following
It is the clinicians responsibility to ensure that accurate
clinical information appears on the request form or is communicated
to the blood bank.