Use of irradiated blood products for febrile neutropenic patients

A pathology resident in training in Oklahoma would like feedback regarding the use of irradiated blood products for febrile neutropenic patients. Recently her transfusion service has been receiving many requests for irradiated blood products to be used in patients with neutropenia/neutropenic fever. To the best of her knowledge there is no specific indication to give patients irradiated products merely because they are neutropenic, and she has conveyed this information to the clinicians. However, the clinicians at her hospital have challenged this information by stating that neutropenia is a state of immunodeficiency---hence their patients should be administered irradiated blood products. She wonders what is the practice at other institutions?

ADDENDA Sept. 29, 2008

1. A transfusion medicine physician who is extremely familiar with the use of irradiated blood products and who is located in upstate New York is of the opinion that except for patients with congenital severe immunodeficiency syndromes, there are only sparse data supporting who should receive irradiated blood for prevention of graft versus host disease (GVHD), which is a rare complication of transfusion. Case reports and series of GVHD after transfusion include patients undergoing myeloablative chemotherapy for leukemia or lymphoma, patients undergoing cardiac surgery with no obvious immune deficiencies, patients with solid tumors undergoing chemotherapy and others not conventionally defined as immune deficient. This presents a dilemma in that the only alternative to universal irradiation (which has been employed in some hospitals) is selective irradiation. But who gets selected to receive irradiated cellular blood products varies very much from institution to institution. Most centers that perform selective irradiation would include patients with neutropenia/neutropenic fever when this is due to myeloablative chemotherapy for leukemia, lymphoma or stem cell transplant. As for neutropenia/neutropenic fever due to other disorders such as auto-immune neutropenia, aplastic anemia, etc. there is probably no uniformity of practice or opinion. One interesting and promising report [Williamson LM, Stainsby D, Jones H, Love E, Chapman CE, Navarrete C, Lucas G, Beatty C, Casbard A, Cohen H. The impact of universal leukodepletion of the blood supply on hemovigilance reports of posttransfusion purpura and transfusion-associated graft-versus-host disease. Transfusion. 2007 Aug;47(8):1455-67] is that the British SHOT surveillance system documented a dramatic drop in case reports of transfusion GVHD after the implementation of universal leukoreduction in the UK.

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