Synopsis
Select the correct component modification for graft-versus-host disease, cytomegalovirus or severe allergy risk and communicate time-limited and lifelong requirements reliably.
- Irradiation prevents transfusion-associated graft-versus-host disease by disabling donor T-lymphocyte proliferation; it does not remove antibodies, prevent CMV or wash away plasma proteins.
- Irradiate all cellular components donated by first- or second-degree relatives, HLA-selected platelets and granulocyte components; plasma and cryoprecipitate do not require irradiation.
- Hodgkin lymphoma and treatment with purine analogues generally create indefinite irradiation requirements under BSH guidance.
- Allogeneic and autologous stem-cell transplantation and CAR-T therapy require irradiated cellular components over defined windows that must be calculated and recorded by the treating service.
- Irradiation is not routine solely for acute leukaemia, most non-Hodgkin lymphoma, HIV, aplastic anaemia without relevant immunosuppression or a solid tumour; check treatment-specific exceptions.
- CMV-negative red cells and platelets are indicated for intrauterine transfusion and neonates up to 28 days after the expected date of delivery under current SaBTO policy.
- Use CMV-negative granulocytes for CMV-seronegative recipients because granulocytes cannot be effectively leucodepleted.
- Where possible, provide CMV-negative red cells and platelets for pregnant patients needing recurrent elective transfusion during pregnancy regardless of CMV serostatus, but leucodepleted blood is acceptable for emergency transfusion and labour or delivery.
- Universal UK leucodepletion provides adequate CMV risk reduction for most other recipients, including haemopoietic stem-cell and solid-organ transplant patients under SaBTO guidance.
- Washed red cells or platelets remove most residual donor plasma and are used for recurrent severe allergic reactions or selected patients with IgA deficiency, anti-IgA and a compatible reaction history.
- Washing takes time, reduces component yield and shortens post-processing shelf life; arrange elective support early and do not delay life-saving standard blood without senior discussion.
- Record the reason, component types, start date and stop date or indefinite status in the transfusion laboratory, oncology or transplant plan, discharge summary and patient alert.
Key red flags
A history of Hodgkin lymphoma, purine-analogue therapy, stem-cell transplant, CAR-T therapy or congenital cellular immune deficiency may create a prolonged or lifelong irradiation requirement.
Directed cellular donation from a first- or second-degree relative and HLA-selected platelets require irradiation because donor lymphocytes may evade recipient immune rejection.
Fever, rash, diarrhoea, hepatitis and pancytopenia 1–2 weeks after a non-irradiated component suggests TA-GVHD and requires urgent haemovigilance investigation.
Recurrent severe allergic reactions or confirmed IgA-related anaphylaxis require specialist component planning before the next elective transfusion; antihistamine premedication alone is inadequate.
Special requirements lost at transfer, discharge, shared care or electronic-system boundaries are a major preventable hazard; patient-held information is an additional safety layer.
Investigation priorities
Identify lifelong and time-limited irradiation indications before component selection.
Retrieve current flags, prior reactions, antibodies and previously authorised modifications.
Management branches
A patient has immune deficiency, haematological therapy, transplant, CAR-T or a special donor relationship.
- Verify diagnosis, drug and procedure dates against BSH criteria and the treating centre's written plan.
- Flag every cellular component that requires irradiation, including HLA-selected platelets and directed family donations.
- Record start and stop dates or indefinite status in laboratory and clinical systems and give the patient durable alert information.
Life-threatening haemorrhage or anaemia cannot wait for the preferred special component.
- Escalate directly to the transfusion consultant and state exact indication, urgency and available stock.
- Use the safest immediately available compatible component when senior assessment concludes delay is more dangerous, with resuscitation readiness.
- Document the decision, restore the full modification as soon as possible and report any missed-requirement process failure.