Content: 

Objectives

After reading this chapter the learner will:

Reading Assignment

Transfusion-Associated Graft-versus-Host Disease (TA-GVHD)

• Specify product requirements that may lead to the development of TA-GVHD.

P 166

Clinical Features

• Compare the clinical features of TA-GVHD and the interval between transfusion and disease onset in neonates and adults.
• Identify the primary reasons for death due to TA-GVHD.
• Differentiate between TA-GVHD and GVHD occurring after HSC transplantation.

P 167

Prevention

• Specify the organization that regulates blood irradiators in the United States.
• Identify the methodology for leukocyte inactivation that inhibits activation and proliferation in platelets and whole blood.
• Specify the recommended dose for ionizing radiation sufficient to inhibit lymphocyte proliferation but not to significantly damage red blood cells (RBCs), platelets and granulocytes or their functions.
• Describe the effects of irradiation on stored products.
• Identify patients sensitive to increased potassium resulting in transfusion-associated hyperkalemia.
• Specify the transfusion practices that may benefit patients sensitive to the increased potassium associated with irradiated RBCs.

Pp 167-169

Blood Component Factors

• Specify the product that should always undergo irradiation prior to transfusion and the remaining cellular blood components irradiated for patients at increased risk.
• Identify what we have learned from case reports or hemovigilance data about the risks of developing TA-GVHD.
• Specify the recommended expiration date for red blood cells that have been irradiated.

Pp 169-170

Patients at Increased Risk

• Name the diagnosis and/or possible risk factor in the 2012 TA-GVHD case reported to SHOT.
• Match the at-risk patients to the indications for irradiated cellular blood components to prevent TA-GVHD.

Pp 170-175

Guidelines and Requirements for Irradiated Products

• List TA-GVHD risk factors and preventive measures related to the population of Japan.
• Specify the practice most frequently indicated for blood product irradiation according to the 2014 College of American Pathologists (CAP) member survey.
• Identify the results from the 2014 CAP member survey regarding blood product irradiation practices.

Pp 176-177

Pathogen Inactivation

• Compare pathogen inactivation (PI) technology to irradiation.

P 177

Hemovigilance

• Identify reasons why there have been no TA-GVHD fatalities reported to the U.S. Food and Drug Administration since 2011 and only a low incidence of reported TA-GVHD.

P 177

Transfusion-Associated Microchimerism (TA-MC)

• Specify the term that refers to the persistence of allogeneic donor lymphocytes in a recipient.
• Discuss the clinical significance of TA-MC.

Pp 177-178