The Technical Director of a blood center in Northern California received a request from one of their hospital clients to provide irradiated Fresh Frozen Plasma (FFP). The inquiring colleague wonders if anyone provides this component, and if so, what is the scientific basis?

In addition, a blood center medical director in Northern California (at a different blood center than the above colleague) asks, "Should post donation leukocyte reduced fresh frozen plasma be irradiated prior to administration to an immunocompromised patient?" He asks because one of their clinical oncologists is requesting this product following the rationale that leukoreduction is just that, reduction, not complete clearance and assuming that there might be viable lymphocytes remaining in the FFP product after freezing and thawing. He did a quick search of the literature and found a case of transfusion induced GVH presumed to be caused by FFP in an infant with DiGeorge syndrome back in the 80's. (Wintergerst U, et al. Graft versus host reaction in an infant with DiGeorge syndrome [Article in German] Monatsschr Kinderheilkd. 1989 Jun;137(6):345-7. Surveying two nearby blood centers came up with two different answers, one doesn't provide the product and one does. He asks “What to do?”

The following responses have been received.

1. At least one pediatric care hospital transfusion service in Southern California acknowledges that they irradiate FFP, after the product is thawed.

2. According to a blood center physician in Sacramento, a number of their 'local hospitals' request that the blood center irradiate frozen "acellular" blood components (e.g., FFP and CRYO), based upon work that they and others reported which demonstrate that post-thaw FFP contains relatively large numbers of viable mononuclear cells, including T lymphocytes.

3. Editor's Note: The following are germane is the current discussion: Bernvil SS, et al. Fresh frozen plasma contains viable progenitor cells--should we irradiate? Vox Sang. 1994;67(4):405; and attached abstracts (PDF). The following previous e-Network Forum discussions may also be relevant: Policies regarding irradiation of blood donated by blood relatives and How long do indications for irradiated blood products continue for patients achieving a "cure" of the originally qualifying condition?

ADDENDA July 18, 2006

4. A respected Department Chair from the East Coast writes that irradiation of cellular blood components administered to severely immunocompromised patients is clearly required and it is easy and prudent to irradiate all blood components administered to these patients, but points out that there has not been a well documented case of GvHD caused by fresh frozen plasma (FFP). He mentions the case report of Wintergerst et al. (Wintergerst U, et al. Graft versus host reaction in an infant with DiGeorge syndrome Monatsschr Kinderheilkd. 1989 Jun;137(6):345-7), which describes an infant with DiGeorge syndrome who has GvHD by histologic diagnosis at autopsy. He writes that, to implicate FFP, lymphocytes from the tissues should be shown to come from the FFP donor, or at the very least that donor and recipient share appropriate HLA haplotypes, but there is no evidence to implicate the FFP donation. He further states that if the lethal illness was GvHD, and this is likely, but not definitive, it might well have resulted from under-irradiation (or error in irradiation) of the cellular components which included fresh blood, and, furthermore, that several cases of GvHD have been reported in non-transfused infants with the DiGeorge syndrome as a result of proliferation of maternal lymphocytes – chimerism is common at birth.

ADDENDA July 28, 2006

5. A Physician Consultant in Transfusion Medicine from the UK writes that the UK British Committee for Standards in Haematology (BCSH) guidelines on gamma irradiation of blood components (available at http://www.bcshguidelines.com/pdf/trans37.pdf) state that it is not necessary to irradiate FFP, cryoprecipitate or fractionated plasma products and that these guidelines have been followed in the UK for some years.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator

W. Tait Stevens, MD
CBBS e-Network Forum Assistant Editor & Moderator