Missed irradiation of cellular blood components for vulnerable patients: Insights from 10 years of SHOT data.

Autor: Elliot J; Serious Hazards of Transfusion Office, Manchester Blood Center, UK., Narayan S; Serious Hazards of Transfusion Office, Manchester Blood Center, UK., Poles D; Serious Hazards of Transfusion Office, Manchester Blood Center, UK., Tuckley V; Serious Hazards of Transfusion Office, Manchester Blood Center, UK., Bolton-Maggs PHB; Serious Hazards of Transfusion Office, Manchester Blood Center, UK.; Faculty of Biology, Medicine and Health, University of Manchester, UK.
Jazyk: angličtina
Zdroj: Transfusion [Transfusion] 2021 Feb; Vol. 61 (2), pp. 385-392. Date of Electronic Publication: 2020 Nov 21.
DOI: 10.1111/trf.16189
Abstrakt: Background: Irradiation of cellular blood components is recommended for patients at risk of transfusion-associated graft-vs-host disease (TA-GvHD). Prestorage leucodepletion (LD) of blood components is standard in the UK since 1999.
Study Design and Methods: Analysis of 10 years' reports from UK national hemovigilance scheme, Serious Hazards of Transfusion (2010-2019), where patients failed to receive irradiated components when indicated according to British Society for Haematology guidelines (2011).
Results: There were 956 incidents of failure to receive irradiated components all due to errors. One hundred and seventy two incidents were excluded from analysis, 125 of 172 (72.7%) because of missing essential information. No cases of TA-GvHD were reported in this cohort. The 784 patients received 2809 components (number unknown for 67 incidents). Most failures occurred in patients treated with purine analogues (365) or alemtuzumab (69), or with a history of Hodgkin lymphoma (HL) (192). Together these make up 626 of 784 (79.9%). Poor communication is an important cause of errors.
Conclusion: Leucodepletion appears to reduce the risk for TA-GvHD. None of 12 cases of TA-GvHD reported to SHOT prior to introduction of LD occurred in patients with conditions recommended for irradiated components by current guidelines. Irradiation indefinitely for all stages of HL is not based on good evidence and is a difficult guideline to follow. Further research on long-term immune function in HL is required. Variation between different national guidelines reflects the very limited evidence.
(© 2020 The Authors. Transfusion published by Wiley Periodicals LLC. on behalf of AABB.)
Databáze: MEDLINE
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