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Oral Abstract

Transfusion Service - Transfusion Practices

Oral Abstract Session - Non-Infectious Hazards of Blood Transfusion

#OA2-AM25-SN-09 - Changes in Irradiation Practices as Revealed by 2024 Survey

Sunday, October 26, 2025
2:30 PM - 3:30 PM  PT
Room: SDCC 30AB
Oral Abstracts

    Presenting Author(s)

  • Elizabeth A. Godbey, MD

    Director of Transfusion Medicine, Director of Apheresis, Associate Director of Pathology Residency Program
    Mayo Clinic Florida
    Atlantic Beach, Florida

    Disclosure information not submitted.

Background/Case Studies: Transfusion-Associated Graft-versus-Host Disease (TA-GVHD) is a rare but fatal delayed condition associated with transfusion of cellular blood products. Irradiation for at-risk patient populations prevents TA-GVHD. The FDA does not mandate specific indications; our group’s last international survey on this topic showed varied practices. The objectives of this 2024 study were to describe contemporary irradiation practices, compare them to our 2014 findings, and inform future education efforts.

Study

Design/Methods:

The CAP Transfusion, Apheresis, and Cellular Therapy Committee developed a 13-question survey and distributed it to 3509 transfusion services in Fall 2024. Questions assessed irradiation availability, decision-making, sourcing, and indications. A chi-square test was used to compare categorical variables, and the Kruskal-Wallis test was used for continuous variables, with p< .05 considered significant.

Results/Findings:

We received survey responses from 2771 sites, 83.5% (2315/2771) of which were in the United States. Most (2437/2737, 89.0%) provided irradiated products, and almost all (2400/2469, 97.2%) allowed ordering providers to initiate irradiation requests. About half (1135/2266, 50.1%) had a process allowing for pathologist adjudication of irradiation requests. Of these institutions, 60.6% (673/1110) always involved ordering physicians prior to canceling an irradiation order. Most sites (2117/2460, 86.1%) purchased irradiated products, 13.3% (328/2460) irradiated on-site via x-ray, and 6.8% (168/2460) irradiated on-site via gamma irradiator. On-site irradiation was highly associated with annual number of transfusions (p< .001). Few (119/2526, 4.7%) institutions provided irradiated products to all patients; this practice was highly associated with the presence of a bone marrow transplant service at the site (p< .001). Some institutions (1064/2407, 44.2%) provided universal irradiation to certain patient groups or services (e.g. bone marrow transplant [496/1064, 46.6%], pediatrics [165/1064, 15.5%]). Rarely, (56/2262, 2.5%) institutions irradiated based on patients’ absolute lymphocyte count. We identified that the proportion of institutions irradiating products for specific indications differed significantly compared to our prior 2014 survey (Table 1).

Conclusions:

To our knowledge, this is the largest and most detailed contemporary survey of irradiation practices for the prevention of TA-GVHD. Survey responses revealed significant changes in irradiation practices since 2014, including decreases in the proportions of sites irradiating products for indications recommended by consensus guidelines. These findings may reflect local shifts in patient populations and/or other changes in practice, such as implementation of pathogen-reduced platelets. Irradiation education outreach efforts may be helpful to protect at-risk populations.