Irradiation eradication and pathogen reduction. Ceasing cesium irradiation of blood products

The irradiation of cellular blood components to prevent transfusion-associated (TA)-GVHD is an established practice in the developed world. Susceptible patients include those who are immunosuppressed, fetuses, very premature neonates and patients who have an increased likelihood of possessing one HLA haplotype for which the blood component donor is homozygous. Problems and challenges associated with blood component irradiation include transfusion delay, cost, failure to irradiate when indicated, increased potassium accumulation in and decreased shelf life of RBC units, reduced RBC recovery and, in the United States, substantial and onerous security requirements for cesium-137 source irradiators and their operators. Microbial contamination of blood components can pose life-threatening risks for transfusion recipients. Donor history screening and infectious disease testing are a reactive response and expensive, as well as an imperfect and incomplete means for preventing these infectious risks. In response to these threats, pathogen reduction technologies have been developed. Two such innovations (INTERCEPT, Cerus Corporation, Concord, CA, USA; and Mirasol, CaridianBCT Biotechnologies, Lakewood, CO, USA) are approved for clinical use in many countries, though not in the United States. These processes have been shown to effectively prevent proliferation of nucleic acid-containing microbes, thereby providing broad protection against transfusion-transmitted infection. These technologies have also been shown to prevent the replication of WBC. In this report, we review the substantial in vitro, clinical trial and clinical practice observational evidence that non-irradiated INTERCEPT- and Mirasol-treated cellular blood components do not cause TA-GVHD. Implementation of these processes precludes the necessity for irradiating cellular blood components to prevent TA-GVHD.