Irradiation prevents TA-GHVD, a lethal transfusion complication. But does it really do what you think it does?
NOTE: Continuing Education credit for this episode has expired. See below for details.
Dr. Chris Tormey
Dr. Chris Tormey
About My Guest:
Chris Tormey, MD, is a pathologist who is board-certified in Clinical Pathology as well as Blood Banking/Transfusion Medicine. He is an Associate Professor in the Department of Laboratory Medicine at Yale University in New Haven, CT. He serves as Medical Director of Transfusion Services at both Yale-New Haven Hospital in New Haven, CT and VA Connecticut Healthcare in West Haven, CT; he also provides clinical pathology and laboratory hematology services at Yale-New Haven Hospital. Dr. Tormey is the Director of the Transfusion Medicine fellowship program at Yale, and teaches students, residents, and fellows at the Yale School of Medicine.
Chris has several investigative interests, including alloimmunization to non-ABO antigens in the settings of transfusion or pregnancy. He is widely published, and has won several awards for his research and teaching efforts. In 2014, the American Society for Clinical Pathology named him to the prestigious “40 under Forty” list of outstanding young leaders in pathology.
Dr. Tormey is a graduate of New York Medical College and trained in Clinical Pathology and Blood Banking/Transfusion Medicine at Yale.
Continuing Education Expired
This podcast episode offered continuing education credit for two years from its release date, but is no longer eligible for such credit.
To find Blood Bank Guy Essentials Podcast episodes with active continuing education opportunities, Click here or visit Transfusion News Continuing Education on Wiley Health Learning.
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Tormey nor I have any relevant financial disclosures.
Further Reading:
- Irradiation article discussed in this episode: Bahar B and Tormey CA. Prevention of Transfusion-Associated Graft-Versus-Host Disease with Blood Product Irradiation: The Past, Present, and Future. Arch Pathol Lab Med 2018;142:662-667.
- British Guidelines on Irradiation: Treleaven J et al. Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force. Brit J Haem 2011;152:35-51.
- UPDATED British Guidelines on Irradiation: Foukaneli T et al. Guidelines on the use of irradiated blood components. Brit J Haem 2020;191:704-724.
- Canadian Review article mentioned during the interview: Kopolovic I et al. A systematic review of transfusion-associated graft-versus-host disease. Blood 2015;126(3):406-414.
Image courtesy of LifeStream Blood Bank, San Bernardino, CA.
Thanks to:
- Dr. Daniela Hermelin, Assistant Editor; Follow Daniela on Twitter for fantastic #blooducation!
- Samantha Chaffin, Design and content consultant
Music Credit
Music for this episode includes "Cuando te invade el temor" and "Reflejo," both by Mar Virtual via the Free Music Archive. Click the image below for permissions and license details.
Excellent!
Hi Dr. Chaffin, great interview and thanks to Dr. Tormey. Thirty years, four states, ten hospitals later, Your work here makes me even smarter. Look forward to listening on my very long drive home from work. Keep up the GREAT work. Absolutely rewarding.
Thank you so much.
Connie MS, SBBCM.
Wow, Connie, what an honor! Thank so much for the kind words. I just do my best to bring you and everyone else the words of really smart people who are really interested in helping others understand Transfusion Medicine. I’m very glad you find it useful.
-Joe
Thanks for this podcast Joe and Chris. Misunderstanding regarding the use of irradiated blood products is really an issue we face very often in our facility.
Is neutropenia (either acquired or inherited/congenital) an indication for use of irradiated blood?
Interesting question. People with neutropenia do get irradiated products (for example, those who need granulocyte transfusions, as Dr. Tormey mentioned), but by itself, neutropenia is not necessarily a big risk. We are usually more concerned about lymphopenia instead, as it’s thought that not having enough lymphocytes to neutralize the transfused T-lymphs is one pathway to TA-GVHD.
-Joe
Thanks Joe and Chris for the excellent podcast!
I just have one question in my mind.
You have mentioned that patients on purine analog need irradiated blood product. How about after they discontinue the purine analog treatment? How long should they still receive irradiated blood product? Or you would rather continue giving the patients the irradiated blood product due to minimal risk ?
Thanks
Hi Murphy, and thanks for the kind words! I’m glad you enjoyed the episode. Dr. Tormey is a star.
I’m actually very glad you asked this question, as it caused me to research the issue of whether receiving a purine analog like fludarabine is a permanent indication for irradiated cellular blood products. I wouldn’t have thought so, BUT if you look at the package insert for fludarabine, here’s what you will find in the “Warnings” section: “Transfusion-associated graft-versus-host disease has been observed after transfusion of non-irradiated blood in fludarabine phosphate, USP treated patients. Fatal outcome as a consequence of this disease has been reported. Therefore, to minimize the risk of transfusion-associated graft-versus-host disease, patients who require blood transfusion and who are undergoing, or who have received, treatment with fludarabine phosphate, USP should receive irradiated blood only.” (emphasis added). So, according to the PI, it looks like a permanent thing.
-Joe