Blood Component Modification

Recommendations

1. For patients with negative or unknown CMV serology.

2. Leukocyte depletion may be used if CMV negative blood components are not available.

3. All components for stem cell transplant patients require irradiation. All directed donations from family members or HLA matched donors require gamma irradiation.

4. Gamma irradiation is required pre-transplant for patients who may receive non-myeloablative ("mini") transplants.

5. Required to prevent alloimmunization pre-transplant only.

6. Irradiation may be indicated in severely immunosuppressive chemotherapy, such as is used to treat patients with acute leukemia, or with fludarabine rx.

7. Leukocyte reduced blood is recommended for patients who will undergo multiple cycles of chemotherapy that will require platelet transfusion support.

8. If uncontrolled by leukocyte depletion, volume depletion of platelets prior to transfusion may decrease febrile reactions.

CMV Negative
CMV negative patients who are, or will be, severely immunosuppressed due to transplantation should receive only CMV negative platelets, and red blood cells to prevent primary CMV infection.

Premature infants and low birth weight neonates should receive CMV negative blood components regardless of serology.

Leukocyte depletion of blood is equivalent to CMV screening but is more expensive and indicated only if CMV negative blood is not available.

Irradiation (gamma)
Inactivation of lymphocytes prevents transfusion induced GVHD due to engraftment of donor cells in an immunosuppressed patient.

Leukocyte-reduction ("leukopoor")
Removal of leukocytes by filtration of platelets and red blood cell concentrates is indicated for febrile transfusion reactions and when CMV negative components are indicated but not available.

Leukocyte depletion my prevent alloimmunization to platelets and should be used in patients who are expected to need platelet transfusions during multiple courses of chemotherapy and do not have pre-existing HLA antibodies.

Volume Reduced Platelets
Removal of excess donor plasma is indicated in patients who cannot tolerate the full volume or when ABO incompatible single donor platelets are transfused. Volume reduction may be helpful in patients with febrile transfusion reactions that persist despite leukocyte reduction. Approximately 10% of the platelets are lost in this process and the extra centrifugation step may cause some platelet activatioin and loss of function.

Washed Red Blood Cells and Platelets
Patients with severe life threatening plasma allergies uncontrolled by medications or volume reduction may require red blood cells or platelets to be resuspended in saline. Washed red blood cells must be transfused within 24 hours or be wasted. The recovery and function of platelets after washing are severely impaired.