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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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.”

9. 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

10. 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