Background/Case Studies: The irradiation of cellular blood products by x-ray or gamma irradiation for transfusion is done to prevent against Transfusion Associated Graft vs Host Disease. At our institution, we perform a location-based review on all units ordered from the outpatient cancer center and the inpatient cancer floors. We present results of our study evaluating the efficacy of a location-based irradiation review of issued cellular blood products.
Study
Design/Methods: At our institution, any unit ordered as irradiated from the indicated locations we issue as irradiated. Any unit from the indicated locations ordered as non-irradiated wherein the patient does not have the results of a previous review in our laboratory information system (LIS), we perform a review on. The tech records this patient as “irradiation pending review” in the LIS and notifies the Pathology resident on the Blood Bank service to review the case. The resident then evaluates the patient’s chart to identify if any widely accepted indications exist to issue an irradiated blood product. If blood is needed before the review is completed, irradiated units are issued. A retrospective analysis over a six-month period (April 2022-September 2022) was performed to identify the number of orders placed requiring a review and the frequency of orders for non-irradiated blood where a clear indication existed.
Results/Findings: In total, 516 cellular blood product orders were placed which required an irradiation review. 71% (366/516) of products were ordered as non-irradiated and did not have an indication for irradiation. However, 16% (84/516) of cellular blood products were ordered as non-irradiated by clinicians and were determined to need irradiation following a review of the patient’s clinical history. 10% (52/516) of the cellular blood products were ordered as irradiated, and a review indicated an appropriate indication, and 2% (8/516) were ordered as irradiated, but a review determined there was no clinical indication for product irradiation. Conclusions: While the responsibility of appropriately ordering irradiated products for patients ultimately falls on the clinical ordering team, a location-based irradiation review in the blood bank can serve as a safety check in identifying indications where irradiation may be clinically beneficial. A typical irradiation review takes an average of five minutes, and 516 irradiation requests over a six-month period average 3.9 irradiation reviews per working day. While we recognize this may add additional daily responsibilities in performing a thorough clinical review, we do not feel this is a burdensome time requirement for ensuring patient safety. Over the six-month period at our large, 1300 bed academic institution, we identified 84 cases where patients likely benefitted from a location-based irradiation review, supporting the case for continued implementation.
Importance of research: As caregivers, our first priority is promoting and ensuring patient safety. Inpatient cancer floors and outpatient cancer centers typically serve a population with a higher percentage of patients who may require irradiated blood products. A location-based irradiation review in the blood bank that targets specific areas of the hospital, may help identify orders for non-irradiated blood that ultimately require irradiation.
