Guidelines on gamma irradiation of blood components for the prevention of transfusion-associated graft-versus-host disease
Guidelines on gamma irradiation of blood components for the prevention of transfusion-associated graft-versus-host disease
复制标题
DOI：
10.1111/j.1365-3148.1996.tb00078.x
复制
发表时间：
1996-09-01
影响因子：
1.5
通讯作者：
Webb, D
中科院分区：
文献类型：
--
作者：
Chapman, J;Finney, RD;Webb, D
输血相关移植物-vs.宿主病（TAGVHD）是一种罕见但通常致命的输血并发症。美国血库协会1990年的调查显示，在13.82106例非辐照成分输血的情况下，有12例（安德森等人，1991年）。与个体输血相关的风险取决于污染淋巴细胞的数量和活力、患者免疫系统对其植入的易感性以及供体和患者之间的免疫学（HLA）差异程度。在文献中，作为临床实践指南基础的科学信息相对较少，并且在不同的临床环境中没有精确的TA-GVHD风险估计。细胞血液成分的γ辐照一直是TAGVHD预防的主要手段，但是在美国和英国对血库的调查已经揭示了辐照剂量、临床适应症和质量控制在中心之间的广泛差异（安德森等人，1991年）。因此，本指南文件将考虑：（i）各种临床环境中TAGVHD的频率、临床特征和诊断，以及应考虑预防TAGVHD的患者群体的建议;（ii）通过血液成分的伽马辐照预防TAGVHD，以及应进行此类处理的成分;（iii）伽马辐照对血液成分功能、储存和标签的影响，以及对此类成分接受者的任何可能危害;提供血液成分伽马辐照设备和剂量测定并进行质量控制。该文献将不讨论血液制品的紫外线照射作为预防HLA同种异体免疫的手段，也不考虑TA-GVHD的治疗。
Transfusion-associated graft-vs.-host disease (TAGVHD) is a rare but usually fatal complication of transfusion. The American Association of Blood Banks survey of 1990 revealed 12 cases in the context of 13.8 2106 nonirradiated components transfused (Anderson et al., 1991). The risk associated with an individual transfusion depends on the number and viability of contaminating lymphocytes, the susceptibility of the patient’s immune system to their engraftment and the degree of immunological (HLA) disparity between donor and patient. There is relatively little scientific information in the literature on which to base guidelines for clinical practice, and no precise estimates of TA-GVHD risk in different clinical settings. Gamma irradiation of cellular blood components has been the mainstay of TAGVHD prevention, but surveys of blood banks in both the USA and UK have revealed wide variations among centres in irradiation dosage, clinical indications and quality control (Anderson et al., 1991). This guideline document will therefore consider:(i) the frequency, clinical features and diagnosis of TAGVHD in a variety of clinical settings, with recommendations of patient groups for whom prevention of TAGVHD should be considered;(ii) prevention of TAGVHD by gamma irradiation of blood components, and the components which should be so treated;(iii) the implications of gamma irradiation for blood component function, storage and labelling, and any possible hazards to recipients of such components;(iv) provision and quality control of equipment and dosimetry for the gamma irradiation of blood components. The document will not discuss ultraviolet irradiation of blood products as a means of preventing HLA alloimmunization, nor will therapy of TA-GVHD be considered.