Hosseini Ehteramolsadat, Kianinodeh Fatemeh, Ghasemzadeh Mehran
Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.
Platelets. 2022 Jul 4;33(5):666-678. doi: 10.1080/09537104.2021.1990250. Epub 2021 Oct 26.
Irradiation of platelet products is generally used to prevent transfusion-associated graft-versus-host disease (TA-GvHD) as well as transfusion-transmitted infections. As an essential prerequisite, gamma-irradiation of blood products prior to transfusion is required in patients who may develop TA-GVHD. Most studies suggest that gamma irradiation has no significant effect on the quality of platelet products; however, more recent studies have shown that the oxidative effects of gamma irradiation can lead to the induction of platelet storage lesion (PSL) and to some extent reduce the efficiency of transfused platelets. As the second widely used irradiation technique, UV-illumination was primarily introduced to reduce the growth of infectious agents during platelet storage, with the advantage that this method can also prevent TA-GvHD. However, the induction of oxidative conditions and platelet pre-activation that lead to PSL is more pronounced after UV-based methods of pathogen reduction. Since these lesions are large enough to clearly affect the post-transfusion platelet recovery and survival, more studies are needed to improve the safety and effectiveness of pathogen reduction technologies (PRTs). Therefore, pointing to other benefits of PRTs, such as preventing TA-GvHD or prolonging the shelf life of products by eliminating the possibility of pathogen growth during storage, does not yet seem to justify their widespread use due to above-mentioned effects. Even for gamma-irradiated platelets, some researchers have suggested that due to decreased 1-hour post-transfusion increments and increased risk of platelet refractoriness, their use should be limited to the patients who may develop TA-GVHD. It is noteworthy that due to the effect of X-rays in preventing TA-GvHD, some recent studies are underway to examine its effects on the quality and effectiveness of platelet products and determine whether X-rays can be used as a more appropriate and cost-effective alternative to gamma radiation. The review presented here provides a detailed description about irradiation-based technologies for platelet products, including their applications, mechanistic features, advantages, and disadvantages.
血小板制品的辐照通常用于预防输血相关移植物抗宿主病(TA-GvHD)以及输血传播感染。作为一项基本前提,对于可能发生TA-GVHD的患者,输血前需要对血液制品进行γ射线辐照。大多数研究表明,γ射线辐照对血小板制品的质量没有显著影响;然而,最近的研究表明,γ射线辐照的氧化作用可导致血小板储存损伤(PSL)的诱导,并在一定程度上降低输注血小板的效率。作为第二种广泛使用的辐照技术,紫外线照射最初是为了减少血小板储存期间病原体的生长,其优点是该方法还可以预防TA-GvHD。然而,基于紫外线的病原体灭活方法导致的氧化条件诱导和血小板预激活导致PSL更为明显。由于这些损伤足够大,足以明显影响输血后血小板的恢复和存活,因此需要更多研究来提高病原体灭活技术(PRTs)的安全性和有效性。因此,尽管PRTs有其他益处,如预防TA-GvHD或通过消除储存期间病原体生长的可能性来延长产品保质期,但由于上述影响,它们似乎仍不能证明其广泛应用的合理性。即使对于γ射线辐照的血小板,一些研究人员也建议,由于输血后1小时的增加值降低以及血小板输注无效风险增加,其使用应仅限于可能发生TA-GVHD的患者。值得注意的是,由于X射线在预防TA-GvHD方面的作用,最近正在进行一些研究,以检查其对血小板制品质量和有效性的影响,并确定X射线是否可以作为γ射线更合适且更具成本效益的替代方法。本文的综述详细描述了用于血小板制品的基于辐照的技术,包括它们的应用、作用机制特点、优点和缺点。