What are your facilities procedures for indicating needing irradiated blood products?

[Mosaics]

What are your procedures particularly for an intended transplant?  Do you ask if it is a solid organ or bone marrow transplant? 

 

Or do you give irradiated blood products to all patients with a history of cancer?

 

Thanks!

[David Saikin]

Primarily an MDs order

other considerations

     immunocompromised pt

     directed donors - genetically related

     Premature infants <1200g at birth (should not happen at my place but it is in my policy)

     HLA matched plt recipient

 

I know some large teaching institutions which irradiate for all patients

[pbaker]

BM/PBSC transplant candidate or recipient

 

The nursing staff asks the patient at admission assessment.  If yes, a notification prints in the blood bank.  If ordered by a physician, we clarify the reason.

 

I once had an ER doc order CMVN Irradiated because he "didn't want his patient to get anything".  When I explained the real reason for the product, he changed his mind.

[AMcCord]

BM/PBSC transplant candidate or recipient

 

The nursing staff asks the patient at admission assessment.  If yes, a notification prints in the blood bank.  If ordered by a physician, we clarify the reason.

 

I once had an ER doc order CMVN Irradiated because he "didn't want his patient to get anything".  When I explained the real reason for the product, he changed his mind.

 

We play this game with everybody except the hem/onc folks both for CMV neg and irradiated. The pediatricians are the worst about CMV neg or nothing (not to mention that they only want O neg - which they don't always get).

[Liz0316]

The following is not pretty, but I finally got the indications to copy and paste. This is what we use for indications for irradiated products, which may be more than normal - however, we do have our own irradiator.

Questions - let me know.

Liz

7. IRRADIATED CELLULAR BLOOD COMPONENTS:

A. Accepted indications:

1. Immunocompromised marrow or organ transplant recipients.

2. Patients with hematologic disorders who will be undergoing allogeneic marrow transplantation imminently.

3. Intrauterine transfusions.

4. Neonatal exchange transfusions or use of extracorporeal membrane oxygenation (ECMO).

5. Neonates or pre-term infants.

6. Lymphoproliferative malignancies treated with Fludarabine.

7. Patients with Hodgkin’s disease.

8. Patients with congenital cell-mediated immunodeficiencies.

9. Recipients of directed donations from biologic relatives.

10. Recipients of donations from HLA-matched donors.

11. Recipients who are heterozygous at an HLA locus for which the donor is homozygous and shares an allele.

B. Possible indications:

1. Individuals getting immunosuppressive therapy, especially when susceptible to opportunistic infections.

2. Cancer patients who are immunosuppressed because of chemotherapy or radiation therapy.

3. Patients with AIDS who have opportunistic infections.