Update – D Morrison October 15, 2015 NAC Irradiation WG Update – D Morrison October 15, 2015

Members of Irradiation WG June 1, 2015 Dana Devine Debra Lane Doug Morrison – WG Chair Brian Muirhead – NAC Chair Susan Nahirniak (regrets) Wendy Peppel (regrets) Lakshmi Rajappannair (regrets) Shelley Stopera – NAC Coordinator

Indications for Irradiation Agreed upon most indications as described in BCSH guidelines Lack of consensus on top-up transfusions for premature neonates Survey 22 Canadian hospitals with level 3A/3B NICU DM to refine survey questions SS to work with work with Manitoba Gov. resource to format survey

Indications for Irradiation continued….. B-cell malignancies (NHL, CLL, MM) jurisdictional decision dependent on Access to drug history Availability of irradiator DM to wordsmith recommendation Inventory of stored irradiated RBC Balance risk of TA-GVHD vs quality of RBC component

Effect of Irradiation on RBC Review data from CBS/CBR study & other recent publications North American standards less stringent than European standards Although current CSA/CSTM standards are unchanged, NAC WG will recommend measures aligned with European Stds

Hemolysis levels are influenced by age at irradiation and length of storage after irradiation Contour map representation of hemolysis levels in all units tested The areas enclosed by the boundaries define the allowable time frames in which red cell concentrates (RCC) may be irradiated and subsequently stored for three different guidelines. 988 RCC in SAGM….Serrano et al. Vox Sang 2013

CSA/CSTM Standards CSA Z902-10, section 7.12.6 Irradiated whole blood and red blood cells shall have a maximum expiration time of 28 days after irradiation or shall retain the original outdate, whichever is shorter. Consistent with FDA standards

Council of Europe Standards 17th edition - 2013 “Red cell components may be irradiated up to 28 days after collection.” “Irradiated cells must be transfused as soon as possible, but no later than 14 days after irradiation and in any case no later than 28 days after collection.”

British Committee for Standards in Hematology Guidelines - 2010 “Red cells may be irradiated at any time up to 14 d after collection, and thereafter stored for a further 14 d from irradiation.” Where the patient is at particular risk of hyperkalemia e.g. intrauterine or neonatal exchange transfusion, it is recommended that red cell be transfused within 24 h of irradiation or that the cells are washed.” Grade 1 recommendation; level A evidence

Irradiation WG – next steps Complete survey Include members from CCNMT – Quebec Advisory Committee on TM Vincent Laroche Nancy Robitaille Update draft NAC recommendations for approval at the next NAC meeting