Why leuko/irridated blood products for chemo patients??

[raindrop]

I am thinking about becoming a Onc nurse, but I"m trying to understand a few things before I apply for this position. I was reading up on some stuff from my old nursing books, and it says that for all chemo patient, that the nurse should question the MD if he/she did not order blood that is leuko-reduced and irridated if a patient is getting chemo. Why does the blood have to be LR and irridated? I understand LR if the patient has lymphoma or leukemia.....but why should all chemo patients get that. And what exactly is irridated? Sorry!!!!!!!

[iluvivt, BSN, RN]

Oncology patients have the propensity to receive many types of blood products during their treatment and management of their disease. Their blood products may require special treatment to avoid some of th.e complications associates with repeated administration of blood and blood products.

Irradiated blood causes the donor lymphocytes to become incapable of replication. This prevents the almost always fatal complication of graft vesus host disease.

Leukocyte-reduced RBCs are one in which the majority of leukocytes are removed via a specialized filter. This will prevent nonhemolytic febrile reaction and HLA alloimmunization. Alloimmunization is the development of an immune response to alloantigens that can occur during pregnancy,blood transfusion,and organ transplantation

[blondy2061h, MSN, RN]

We use only LR/IR products. My understanding is that the irradiated is to kill any germs in the blood that a non immunosuppressed person could simply fight, and the leukocyte reduced is to prevent transfusion reactions since they receive so many transfusions. I wasn't under the impression that it had anything to do with graft-versus-host, as this only happens in transplant patients and it's related to their bone marrow graft.

[iluvivt, BSN, RN]

No it has nothing to do with germs...it is exactly as I explained . Irradiated blood is used to prevent GVHD in pts with all types of Lymphoma,acute Leukemia.Congenital immunodeficiency disorders,pts with malignant tumors that are being treated with immunosuppressive therapy,Low birth rate infants,and intrauterine transfusions. This is the recommendation from the American Association of Blood Banks (AABB technical Manual). As stated the reason for Leukocyte reduced cells is to prevent febrile hemolytic reactions and to decrease the risk for HLA alloimmunization. Also may reduce the risk of CMV transmission.

[blondy2061h, MSN, RN]

But why do you need to reduce the risk of GVHD in non-BMT patients, when there's no risk to begin with?

[blondy2061h, MSN, RN]

I just googled it. Learn something new everyday. There is transfusion-associated graft-versus-host which can happen if severely immunosuppressed patients receive non-IR blood or platelets. I had never heard of it before. The irradiation also kills off certain things, like CMV, as a side benefit.

[anc33]

There is a risk for GvHD is any patient undergoing myeloablative chemo.

[iluvivt, BSN, RN]

When I first started studying about transfusion therapy I was shocked about how much there is to learn. It is a whole science all by its lonesome self. The blood bank used to love my ex husbands blood b/c he was CMV negative and they always wanted him to donate for the pediatric blood stash.

[blondy2061h, MSN, RN]

There is a risk for GvHD is any patient undergoing myeloablative chemo.

What's the graft? Any blood product transfusion?

[anc33]

Sorry, I had a typo in there it should have read "in patients". TA-GvHD happens when the white cells from the bood donor take over in patients who have had myeloablative chemo. When the patients own cells reemerge, the donor cells recognize them as foregin and attack.

[gardengirl63]

We give only leukodepleted blood products and give CMV(-) and irradiated to either those waiting on a BMT or post BMT.