Research Article|Articles in Press, 103651

Demographics and appropriateness of cellular blood component irradiation practices: Ambispective analysis from a tertiary care center

Published:February 01, 2023DOI:



      Transfusion-associated graft versus host disease (TA-GVHD) is often underreported. There may also be lapses in TA-GVHD prevention practices due to lack of revision of some of the existing clinical guidelines as well as limited audits on practices of blood component irradiation. This study was undertaken to highlight these shortcomings, and generate data for development of institutional guidelines.


      Study cohort was selected from patients requiring transfusion support during June 2019 to May 2020. Transfusion history of these patients were followed, both retrospectively and prospectively till July 2021. Transfusion requisitions were categorized as IR (with request for irradiation) or NIR (with no request for irradiation) and justified or unjustified according to published international guidelines.


      Total 6963 requisitions for cellular blood components were received from 255 patients included in the study cohort. Of these, 3690 (54.9 %) were IR requisitions, while remaining 3029 (45.1 %) requisitions were NIR. Overall, 4242 (63.1 %) requisition were justified for their irradiation status as per published guidelines and 1595 (23.8 %) were found to be Unjustified while justification could not be assessed for remaining 882 (13.1 %) of the requisitions. The highest proportion of Unjustified demands in NIR requisitions was observed in patients with Severe Aplastic anemia (59.4 %).


      Many units were unnecessarily irradiated (7.7 %) while irradiation was missed in 16 % of the requisitions included in analysis which may be attributed to lack of institutional guidelines. We recommend that every centre should adopt a published well-researched guideline including amendments based on review of practices at their center.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Transfusion and Apheresis Science
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kopolovic I.
        • Ostro J.
        • Tsubota H.
        • Lin Y.
        • Cserti-Gazdewich C.M.
        • Messner H.A.
        • et al.
        A systematic review of transfusion-associated graft-versus-host disease. Blood.
        J Am Soc Haematol. 2015; 126 (Jul 16): 406-414
        • Marks D.C.
        • Webb R.G.
        • Linnane C.
        • Aung H.H.
        • Dennington P.M.
        • Tan J.C.
        X‐and gamma‐irradiation have similar effects on the in vitro quality of stored red cell components.
        Transfusion. 2021; 61 (Nov): 3214-3223
        • Przepiorka D.
        • Leparc G.F.
        • Stovall M.A.
        • Werch J.
        • Lichtiger B.
        Use of irradiated blood components: practice parameter.
        Am J Clin Pathol. 1996; 106 (Jul 1): 6-11
        • Saito‐Benz M.
        • Murphy W.G.
        • Tzeng Y.C.
        • Atkinson G.
        • Berry M.J.
        Storage after gamma irradiation affects in vivo oxygen delivery capacity of transfused red blood cells in preterm infants.
        Transfusion. 2018; 58 (Sep): 2108-2112
        • Foukaneli T.
        • Kerr P.
        • Bolton‐Maggs P.H.
        • Cardigan R.
        • Coles A.
        • Gennery A.
        • et al.
        Guidelines on the use of irradiated blood components.
        Br J Haematol. 2020; 191 (Dec): 704-724
      1. NAC‐CCNMT Irradiation Working Group, Morrison D, Prokopchuk‐Gauk O, Devine D, Lane D, Laroche V. Recommendations for use of irradiated blood components in Canada. A NAC and CCNMT Collaborative Initiative. 2018. (available at: 〈–08/Recommendations_Irradiated_Blood_〉 Components. pdf).

      2. Australian and New Zealand Society of Blood Transfusion Ltd. Guidelines for prevention of transfusion-associated graft- versus-host disease 2011. 〈〉. Accessed January 10, 2022.

        • Asai T.
        • Inaba S.
        • Ohto H.
        • Osada K.
        • Suzuki G.
        • Takahashi K.
        • et al.
        Guidelines for irradiation of blood and blood components to prevent post‐transfusion graft‐vs.‐host disease in Japan.
        Transfus Med. 2000; 10 (Dec): 315-320
      3. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10), available at- 〈〉, last accessed on 19th Jan 2022.

        • Arber D.A.
        • Orazi A.
        • Hasserjian R.
        • Thiele J.
        • Borowitz M.J.
        • Le Beau M.M.
        • et al.
        The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia.
        Blood, J Am Soc Haematol. 2016; 20 (May 19): 2391-2405
        • Swerdlow S.H.
        • Campo E.
        • Pileri S.A.
        • Harris N.L.
        • Stein H.
        • Siebert R.
        • et al.
        The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood.
        J Am Soc Haematol. 2016; 20 (May 19): 2375-2390
        • Booth C.
        • Winter P.
        • Allard S.
        Challenges in the appropriate use of irradiated blood components at a large UK haemato-oncology centre.
        Vox Sang. 2017; 112: P-627
        • Goel R.
        • Nellis M.
        • Karam O.
        • Hanson S.
        • Tormey C.
        • Patel R.
        • et al.
        Transfusion practices for pediatric oncology and hematopoietic stem cell transplantation patients: data from the National Heart Lung and Blood Institute Recipient Epidemiology and Donor Evaluation Study-III (REDS-III).
        Author Prepr. 2021; (Jan 4)
        • Elliot J.
        • Narayan S.
        • Poles D.
        • Tuckley V.
        • Bolton‐Maggs P.H.
        Missed irradiation of cellular blood components for vulnerable patients: insights from 10 years of SHOT data.
        Transfusion. 2021; 61 (Feb): 385-392
        • Leitman S.F.
        • Tisdale J.F.
        • Bolan C.D.
        • Popovsky M.A.
        • Klippel J.H.
        • Balow J.E.
        • et al.
        Transfusion‐associated GVHD after fludarabine therapy in a patient with systemic lupus erythematosus.
        Transfusion. 2003; 43 (Dec): 1667-1671
        • Anderson K.C.
        • Goodnough L.T.
        • Sayers M.
        • Pisciotto P.T.
        • Kurtz S.R.
        • Lane T.A.
        • et al.
        Variation in blood component irradiation practice: implications for prevention of transfusion-associated graft-versus-host disease.
        Blood. 1991; 77 (May): 2096-2102
        • Pritchard A.E.
        • Shaz B.H.
        Survey of irradiation practice for the prevention of transfusion-associated graft-versus-host disease.
        Arch Pathol Lab Med. 2016; 140 (Oct): 1092-1097
        • Uchida S.
        • Tadokoro K.
        • Takahashi M.
        • Yahagi H.
        • Satake M.
        • Juji T.
        Analysis of 66 patients definitive with transfusion‐associated graft‐versus‐host disease and the effect of universal irradiation of blood.
        Transfus Med. 2013; 23 (Dec): 416-422