Irradiation of fresh whole blood for prevention of transfusion-associated graft-versus-host disease does not impair platelet function and clinical hemostasis after open heart surgery.
Since our previous studies suggested that the transfusion of 1 unit fresh whole blood (FWB) after cardiopulmonary bypass (CPB) using a bubble oxygenator may provide hemostatic benefit equivalent to 8-10 units of platelet concentrates, we have routinely used FWB at the termination of CPB. Two patients who received FWB and developed transfusion-associated graft-versus-host disease (TA-GVHD) prompted us to investigate the effect of irradiation of FWB on platelet and clinical hemostasis. Twenty-four patients were randomized to receive either 1 unit FWB (12 patients), or 1 unit irradiated FWB (IrFWB, 1,500 cGy,12 patients) after CPB. Platelet aggregation on extracellular matrix, studied by a scanning electron microscope and graded from 1 to 4 (from poor to excellent aggregation), was similar in both groups preoperatively [3.3 +/- 0.9 (FWB) and 3.5 +/- 0.5 (Ir FWB)], and at the end of CPB [1.8 +/- 1.2 (FWB) and 1.9 +/- 0.9 (IrFWB)]. Platelet aggregation was similar after transfusion of FWB (3.0 +/- 1.0) and after IrFWB (3.2 +/- 0.8), as was the increase in platelet count. Twenty-four hours total postoperative bleeding was similar (560 +/- 420 and 523 +/- 236 ml for FWB and IrFWB, respectively). We conclude that irradiation of FWB for prevention of TA-GVHD does not impair platelet aggregating capacity, and can be used when blood is donated by the patient's next of kin.
Lavee
J
J
Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Shinfeld
A
A
Savion
N
N
Thaler
M
M
Mohr
R
R
Goor
D A
DA
D000368:Aged; D001769:Blood / Q000528:radiation effects*; D001792:Blood Platelets / Q000648:ultrastructure; D001803:Blood Transfusion / Q000379:methods*; D001026:Coronary Artery Bypass; D005260:Female; D005720:Gamma Rays; D006086:Graft vs Host Disease / Q000517:prevention & control*; D006487:Hemostasis; D006801:Humans; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D010974:Platelet Aggregation; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D065227:Transfusion Reaction