What are indications for irradiated red blood cells (RBCs)?

By William Aird

  • Those at risk for transfusion-associated graft-versus-host disease (TA-GVHD) caused by proliferation of donor T lymphocytes
  • Those who are immunocompromised
  • Those receiving intrauterine transfusion
  • Those with hematologic malignancies or solid tumors, including:
    • Sarcoma
    • Neuroblastoma
    • Hodgkin lymphoma
  • Those who are recipients of marrow or peripheral blood stem cell transplantation
  • Those receiving RBCs from blood relatives or human leukocyte antigen-compatible donors
  • Those receiving fludarabine therapy
  • Those receiving granulocyte transfusions

According to the AABB:


  • Blood components that contain viable lymphocytes may be irradiated to prevent proliferation of T lymphocytes, which is the immediate cause of TA-GVHD.
  • Irradiated blood is prepared by exposing the component to a radiation source.
  • The standard dose of gamma or X-ray irradiation is 2500 centigray (cGy) targeted to the central portion of the container with a minimum dose of 1500 cGy delivered to any part of the component.


  • Patients at risk for TAGVHD, including:
    • Fetal and neonatal recipients of intrauterine transfusions
    • Selected immunocompromised recipients
    • Recipients of cellular components known to be from a blood relative
    • Recipients who have undergone peripheral blood progenitor cell transplantation
    • Recipients of cellular components whose donor is selected for HLA compatibility and recipients of granulocyte transfusions.
    • Patients receiving purine analogues (eg, fludarabine, cladribine) or certain other biological immunomodulators (eg, alemtuzumab, antithymocyte globulin) who may be at risk for TA-GVHD, depending on clinical factors and the source of the biological agent.