Canterbury DHB

Blood Transfusion

Red Cell Transfusion

Refer to the Haematology specific procedure 5056 Verbal Orders for Platelets and Red Blood Cell Transfusions for Haematology Patients.

Blood Filters

The standard in-line blood filters (first generation filters) used for most blood transfusions work as simple sieves. The mesh of these filters varies but is commonly 170-200 micron. Blood is now leucodepleted at source and therefore second and third generation filters are no longer required for haematology patients.

Leucodepletion

• Does not prevent blood transfusion-associated graft versus host disease. It must not be used as a substitute for irradiation when irradiated blood is indicated.
• Reduces recurrent non-haemolytic febrile transfusion reactions.
• Reduces transmission of CMV and HTLV.
• Reduces alloimmunisation against HLA antigens and therefore subsequent platelet refractoriness.

CMV Negative Blood

Within NZBS all donor products are now leucodepleted at source, which is deemed sufficient to limit CMV exposure via blood products.

Refer to the NZBS clinical guideline: NZBS Policy on the Provision of CMV Antibody Negative Blood Components (111P067)

See also the CDHB Blood and Blood Product Policy.

Irradiated Blood

See NZBS Transfusion Medicine Handbook.

Definite indications

These are indications where there is strong evidence to support the requirement for use of irradiated blood components or where there is clear consensus on the requirement within published guidelines. Cellular blood products are irradiated to at least 25 Gy. Definite indications include:

• In both autologous and allogeneic SCT, blood products need to be irradiated from 2 weeks before the start of conditioning and 2 weeks before any stem cell harvest.
• Allogeneic transplant patients: for one year after transplant or until immunosuppression medication is stopped (whichever is longer). Patients with active chronic post-transplant GVHD should continue to receive irradiated products.
• Autologous Bone Marrow/PBSC Transplant recipients: for 6 months
• Congenital Cellular Immunodeficiency Disorders
• Intrauterine and all subsequent transfusion and neonatal exchange transfusions
• Patients treated with purine nucleoside analogues fludarabine/cladribine/pentostatin as well as as the related agent bendamustine irradiate blood for a minimum of six months or if evidence of ongoing immunosuppression, until the CD4 count is greater than 0.4 x 10⁹/L. Consider lifelong irradiated blood products with these agents.
• Hodgkin's lymphoma
• Dedicated [directed] donations (from blood relatives)
• HLA-matched platelets
• Granulocyte transfusions
• Alemtuzumab for malignant or non-malignant disorders, for 12 months (at least) from last dose
• Aplastic anaemia, which will potentially proceed to an allogeneic transplant

Possible indications

This includes settings where case reports have been published but where no controlled studies are available. Irradiation is not required in published international guidelines. Possible indications include:

• T-cell malignancies
• Patients with B-cell malignancy who receive chemotherapy and/or radiotherapy leading to lymphopenia <0.5 x 10⁹/L
• Therapeutic antibodies against T-cells
• Acute Leukaemia
• Aplastic anaemia receiving immunosuppressive therapy
• Any patient who receives high doses of chemotherapy and/or irradiation sufficient to cause lymphopenia <0.5 x 10⁹/L
• Patients receiving long term or high dose steroids as therapy for their malignancies
• Premature infants weighing less than 1200 g

No indication (no cases have been reported)

• HIV/AIDS (where none of the above apply)
• Solid organ transplantation
• Congenital humoral deficiency disorder
• Term infants (where none of the above apply)
• Thalassaemias
• Haemophilia

Complete the Irradiated Blood Products Alert Form, ref 2402343 (if applicable).

Blood bank fax no longer in service. Email form to ChristchurchBBeFax@nzblood.co.nz.

Topic Code: 5102