Risk for GVHD related to:
(1) whether or not the recipient is immunocompromised;
(2) the HLA similarity between the donor and the recipient (GVHD may occur in a patient who is immunocompetent if the patient is heterozygous for an HLA haplotype for which the donor is homozygous)
(3) the number of transfused T cells capable of multiplication in the recipient
Well-established need for blood product irradiation:
(1) allogenic bone marrow or peripheral stem cell transplant recipients
(2) autologous bone marrow or peripheral stem cell transplant recipients
(3) granulocyte transfusions
(4) directed donation from blood relative
(5) intrauterine transfusions
(6) exchange transfusion with neonates (following intrauterine transfusion, in premature neonate, in term neonate)
(7) Hodgkin's disease
(8) congenital cellular immune deficiency
Need for blood product irradiation not firmly established but multiple cases of GVHD reported:
(1) solid organ, non-kidney, transplant recipients
(2) non-Hodgkin's malignant lymphoma
(3) acute or chronic leukemia, especially lymphocytic leukemias
(4) nonhematologic malignancies treated with immunosuppressive chemotherapy or radiotherapy
(5) large volume transfusions to premature neonates
(6) extracorporeal membrane oxygenation in neonates
(7) deliberately HLA-matched transfusions
Need for blood product irradiation controversial:
(1) kidney transplant recipients
(2) large volume transfusions in term neonates
(3) immunocompetent nonsurgical patients
(4) pregnancy
(5) general surgical patients
(6) oncologic surgical patients
(7) small volume transfusions to premature neonates
(8) low birth weight neonates (< 1200 grams)
(9) aplastic anemia
(10) HIV-infected patients with opportunistic infections (AIDS)
No need for blood product irradiation:
(1) HIV-infected patients without AIDS
(2) small volume transfusions to full term neonates
(3) elderly patients without a predisposing condition listed above
