Universal Red Blood Cell Irradiation Appears Safe for Sickle Cell Patients

Gabriel Salinas Cisneros, MD

Universal irradiation of blood products does not seem to impact chronic transfusion management in patients with sickle cell disease, suggest findings from a new study.

A team of investigators, led by Gabriel Salinas Cisneros, MD, from Children’s National Hospital, conducted a retrospective patient chart review assessing the potential effects of their center’s policy of universal blood irradiation on transfusion management/requirements.

Prior to the 2018 implementation of the policy, patients who did not receive hematopoietic stem cell transplants did not regularly receive irradiated red blood cell units.

As such, the team evaluated the change in red blood cell transfusion volume per patient weight between the pre-policy implementation and post-implementation periods.

The Study

Overall, Cisneros and colleagues assessed a total of 17 patients with sickle cell disease who received greater than 10 simple red blood cell transfusions. Almost all patients (n = 16) had hemoglobin SS, while 1 had hemoglobin S/β⁰ thalassemia.

All 17 patients received a combined total of 728 transfusions over the 2 study time periods.

In the year preceding the policy implementation, only 3% of 340 units transfused were irradiated—compared with 100% of the 388 units transfused in the post-implementation period.

Among the patient population, “8 (47%) received more red blood cells the year before irradiation and 9 (53%) received more the year after irradiation,” the investigators reported.

“Implementation of universal irradiation did not significantly increase transfusion volumes needed to clinically manage this population (median change, +1.7 ml/kg/year, P = .54),” they wrote.

They further noted that there were no significant differences in change of median pretransfusion absolute reticulocyte count, hemoglobin, hemoglobin S%, white blood cell count, lactate dehydrogenase, total bilirubin, potassium, and serum ferritin.

Even more, they observed that the remaining red blood cell unit shelf life for the pre-irradiation period was 16 days, compared with 17 days for the post-irradiation period (P = .87).

Of the 17 patients, 7 had the exact same number of transfusion events during each period (median, 12 transfusions/year, range, 10–13). According to subgroup analysis, the median change in volume per patient weight was -5.2 ml/kg (P = .99) and the changes in pretransfusion laboratory values were not considered significant.

Conclusion

“These findings are important for hospital systems that have or are considering implementing universal blood product irradiation,” Cisneros and colleagues indicated.

Although previous studies have shown decreased short-term recovery associated with transfused irradiated red blood cell units, longer-term recovery may be largely unimpacted by irradiation — a much more clinically relevant measurement for safety and efficacy.

“It appears that irradiated red blood cell units, particularly with a short post-irradiation storage time, can be provided to patients receiving chronic transfusion who do not require such modification without increasing hemolysis or transfusion requirements,” the investigators concluded.

The study, “Impact of universal irradiation on chronic transfusion for sickle cell disease,” was published online in Transfusion.