Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Irradiated, CMV-negative and washed blood components
Essential points for quick revision.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Life-saving blood when a special component is unavailable
A genuine irradiation, CMV or washing requirement must be honoured whenever possible, but uncontrollable haemorrhage can make delay more dangerous than the residual modification-specific risk.
Action: Call the transfusion laboratory and consultant haematologist or transfusion specialist immediately, state the exact indication and urgency and search local and NHSBT stocks while emergency resuscitation continues. Use the safest immediately available ABO-compatible component under documented senior risk-benefit authority if waiting would threaten life. Do not delay emergency leucodepleted components solely for CMV-negative status in labour or delivery, and restore the full special requirement as soon as supply permits.
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.
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.
Investigation priorities
01
First-line: treatment and diagnosis historyFirst stepFirst line
Identify lifelong and time-limited irradiation indications before component selection.
02
First-line: transfusion laboratory recordFirst line
Retrieve current flags, prior reactions, antibodies and previously authorised modifications.
Management branches
Irradiation assessmentName the indication and duration
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.
Emergency unavailable modificationBalance immediate death against residual risk
Life-threatening haemorrhage or anaemia cannot wait for the preferred special component.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.