Transfusion of blood may cause graft versus host disease (GVHD) in recipients who are immunologically deficient.  GVHD may also occur where there is a high degree of HLA similarity between the donor and recipient.  GVHD is difficult to treat and is almost always fatal.

GVHD is caused by immunocompentent donor lymphocytes which are part of a regular transfusion.  Ordinarily, these transfused lymphocytes are destroyed by the immune system of the recipient.  However, the transfused lymphocytes may survive if the patient’s immune system is compromised by medication, leukocytopenia, disease, irradiation or immaturity.  The transfused lymphocytes may then multiply and attempt to destroy the patient’s body.  The organs most commonly affected are the skin, liver, intestinal tract and bone marrow/lymphoid tissue (resulting in pancytopenia).

Prevention of GVHD in these patients is accomplished by irradiation of all blood components which contain living lymphocytes.  A standard dose of gamma irradiation (1500 cGy gamma irradiation from Cesium 137) prevents multiplication of lymphocytes but does no harm to red blood cells.

Irradiated blood components should be considered in the following transfusion situations:

Irradiated blood components are available as a special order from the Lansing Red Cross.  All blood products, except fresh frozen plasma and cryoprecipitate, are available as irradiated products.  Please order product at least 24 hours prior to anticipated transfusion.

Since GVHD is almost universally fatal, it is important that the ordering physician stipulate "Irradiated" whenever ordering cellular blood products for transfusion to patients susceptible to GVHD.  Each order transmitted to the Blood Bank and each Request to Dispense Blood Products must stipulate “Irradiated” when irradiated blood products are to be provided.

Irradiated blood products are not normally carried in inventory.  Therefore, the physician may wish to order these blood products to be "on hold" when possible transfusion is anticipated.  Availability of irradiated blood products will normally be in 4-6 hours during business hours.  Availability may be 8-12 hours when ordered outside business hours.

It is also important that the transfusionist stipulate "Irradiated RBC" or "Irradiated platelets" when these blood products are to be dispensed.