Xaviar, a newly diagnosed patient with acute myelogenous leukemia, is receiving his first packed red blood cell (PRBC) transfusion. To verify the blood at the bedside, two nurses verbally confirm that the product is O positive, leukocyte reduced, and irradiated. But upon hearing the word irradiated, Xavier’s family becomes concerned that he is receiving something dangerous and state they don’t think he should get the blood.

What Would You Do?

PRBCs and platelets normally contain white blood cells. In some patient populations, such as those with hematologic malignancies, repeated exposure to donor lymphocytes can result in lymphocyte proliferation with the production of CD4+ and CD8+ T lymphocytes. Subsequent cytokine release can result in a condition known as transfusion associated–graft-versus-host disease (TA-GVHD), which has a fatality rate of 90%. Although most leukocytes can be depleted at the blood center after collection, a sufficient number of lymphocytes remain that can cause TA-GVHD. Gamma irradiation is a safe and reliable method of preventing lymphocyte proliferation and TA-GVHD.

The nurse explained to Xavier’s family that the type of radiation used on blood products is completely safe, does not affect transfused red cells or platelets, and that it was not considered “radioactive.” She also helped them understand the purpose of irradiation, which alleviated their concerns.