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W2058442870 abstract "The following were searched systematically for publications in English, until June, 2009: PubMed – from 1950 Medline – from 1950 EMBASE – from 1980 CINAHL (Cumulative Index to Nursing and Allied Health Literature) – from 1982 The Cochrane Library 2008, Issue 3 DARE CRD Website (Centre for Reviews and Dissemination) SRI (Systematic Review Initiative) Handsearch Databases Search terms included: Transfusion-associated graft-versus-host disease, Transfusion-associated graft-versus-host, TA-GvHD. The last guideline covering this topic was published in 1996 (British Committee for Standards in Haematology (BCSH) Blood Transfusion Task Force, 1996. The writing group produced the new draft guideline, which was subsequently revised by consensus by members of the Haemato-oncology and Blood Transfusion Task Forces of the BCSH. The guideline was then reviewed by a sounding board of approximately 100 UK haematologists, the BCSH and the committee of the British Society for Haematology and amended, again by consensus. Criteria used to quote levels and grades of evidence are according to the GRADE system (Guyatt et al, 2006). Strong recommendations (grade 1, ‘recommended’) are made when there is confidence that the benefits either do or do not outweigh the harm and burden and costs of treatment. Where the magnitude of benefit or not is less certain a weaker grade 2 recommendation (‘suggested’) is made. Grade 1 recommendations can be applied uniformly to most patients whereas grade 2 recommendations require judicious application. The quality of evidence is graded as A (high quality randomized clinical trials), moderate (B) or low (C). This publication reports the key recommendations of the Writing Group. It is also accessible at http://www.bcshguidelines.com. To provide healthcare professionals with clear guidance on situations when the use of irradiated blood components is appropriate, and to document any recognized advantages and disadvantages of their use. The guidance may not be appropriate in all patient situations, and individual circumstances may dictate an alternative approach. Studies of patients in all age groups have been considered. • Use of X-irradiation as an alternative to gamma irradiation. • All cases of transfusion-associated graft-versus host disease and all episodes where non-irradiated components are transfused to high risk patients should be reported to national haemovigilance systems [in the UK, the Serious Hazards of Transfusion (SHOT) initiative]. • Irradiated components are recommended for aplastic anaemia patients receiving immunosuppressive therapy with anti-thymocyte globulin (ATG). • Indication for irradiated components extended to newer purine analogues and related drugs until evidence of their safety is forthcoming (e.g. bendamustine and clofarabine). • Irradiated components indicated for patients receiving the biological immunosuppressive agent alemtuzumab (anti-CD52), but not rituximab (anti-CD20) – regular review will be needed as new biological agents enter clinical practice. • All cases of transfusion-associated graft-versus-host disease (TA-GvHD) should be reported to the national haemovigilance system, as should all ‘near misses’ where non-irradiated components are transfused to high-risk patients without incident (1B). • Gamma or X-irradiation of blood components, by validated systems, is the recommended procedure to prevent TA-GvHD (1B). • The minimum dose achieved in the irradiated volume should be 25 Gy, with no part receiving more than 50 Gy (1B). • For at-risk patients, all red cell, platelet and granulocyte concentrates should be irradiated except cryopreserved red cells after deglycerolization. It is not necessary to irradiate fresh frozen plasma, cryoprecipitate or fractionated plasma products (1B). • All donations from first- or second-degree relatives should be irradiated, even if the patient is immunocompetent (1B). • All human leucocyte antigen (HLA)-selected components should be irradiated, even if the patient is immunocompetent (2C). • Red cells may be irradiated at any time up to 14 d after collection, and thereafter may be stored for a further 14 d. Where the patient is at particular risk from hyperkalaemia, e.g. intrauterine or neonatal exchange transfusion, it is recommended that red cells be transfused within 24 h of irradiation or that the cells are washed (1A). • Platelets can be irradiated at any stage during storage and can thereafter be stored up to their normal shelf life after collection (1A). • All granulocyte components should be irradiated before issue and transfused with minimum delay (1C). • Irradiated components not used for the intended recipient can safely be returned to stock to be used for recipients who do not require irradiated components. The reduction in shelf life must be observed (1B). • All irradiated components should be labelled as such, using an approved bar code label. Each unit should be monitored using a radiation-sensitive device, and the result permanently recorded, manually or by computer (1C). • All blood for intrauterine transfusion (IUT) should be irradiated (1B). It is essential to irradiate blood for neonatal exchange transfusion (ET) if there has been a previous IUT or if the donation comes from a first- or second-degree relative (1B). For other neonatal ET cases, irradiation is recommended provided this does not unduly delay transfusion (1C). For IUT and ET, blood should be transfused within 24 h of irradiation and, in any case, by 5 d or less from collection (1A). • It is not necessary to irradiate red cells for routine ‘top-up’ transfusions of premature or term infants unless either there has been a previous IUT, in which case irradiated components should be administered until 6 months after the expected delivery date (40 weeks gestation), or the donation has come from a first- or second-degree relative (2C). • Platelets transfused in utero to treat alloimmune thrombocytopenia should be irradiated and any subsequent red cell or platelet transfusions irradiated until 6 months after the expected date of delivery (40 weeks gestation). There is no need to irradiate other platelet transfusions for pre-term or term infants, unless they have been donated by first- or second-degree relatives (1C). • All severe T lymphocyte immunodeficiency syndromes should be considered as indications for irradiation of cellular blood components. Once a diagnosis of immunodeficiency has been suspected, irradiated components should be given while further diagnostic tests are being undertaken. A clinical immunologist should be consulted for advice in cases where there is uncertainty (1A). • There is no indication for routine irradiation of cellular blood components for infants or children who are suffering from a common viral infection, who are human immunodeficiency virus (HIV) antibody positive, or who have acquired immunodeficiency syndrome (AIDS). However, this should be kept under review. There is also no indication for routine irradiation of cellular blood components for adults who are HIV antibody positive or who have AIDS (2B). • There is no need to irradiate red cells or platelets for infants undergoing cardiac surgery unless clinical or laboratory features suggest a coexisting T lymphocyte immunodeficiency syndrome (2B). • It is not necessary to irradiate red cells or platelets for adults or children with acute leukaemia, except for HLA-selected platelets or donations from first- or second-degree relatives (1B). • All recipients of allogeneic haemopoietic stem cell transplantation (SCT) must receive irradiated blood components from the time of initiation of conditioning chemoradiotherapy (1B). This should be continued while the patient continues to receive graft-versus-host disease (GvHD) prophylaxis, i.e. usually for 6 months post-transplant, or until lymphocytes are >1 × 109/l. If chronic GvHD is present or if continued immunosuppressive treatment is required, irradiated blood components should be given indefinitely (2C). Allogeneic blood transfused to bone marrow and peripheral blood stem cell donors 7 d prior to or during the harvest should also be irradiated (2C). • Patients undergoing bone marrow or peripheral blood stem cell ‘harvesting’ for future autologous re-infusion should receive irradiated cellular blood components during and for 7 d before the bone marrow/stem cell harvest to prevent the collection of viable allogeneic T lymphocytes which can potentially withstand cryopreservation (2C). • All patients undergoing autologous bone marrow transplant or peripheral blood stem cell transplant should receive irradiated cellular blood components from initiation of conditioning chemo/radiotherapy until 3 months post-transplant (6 months if total body irradiation was used in conditioning) (2C). • All adults and children with Hodgkin lymphoma at any stage of the disease should have irradiated red cells and platelets for life (1B). • Patients treated with purine analogue drugs (fludarabine, cladribine and deoxycoformicin) should receive irradiated blood components indefinitely (1B). The situation with other purine antagonists and new and related agents, such as bendamustine and clofarabine, is unclear, but use of irradiated blood components is recommended as these agents have a similar mode of action. Irradiated blood components should be used after alemtuzumab (anti-CD52) therapy. Their use after rituximab (anti-CD20) is not recommended at this time. As new potent immunosupressive drugs and biological agents are introduced into practice there is a need for regular review of these recommendations (2C). • It is not necessary to irradiate blood components for patients undergoing routine surgery, those with solid tumours HIV infection, autoimmune diseases or after solid organ transplantation (unless alemtuzumab (anti-CD52) has been used in the conditioning regimen). The effects of new regimens of chemo- and immunotherapy entering clinical practice must continue to be monitored (2C). • In view of the recent switch from horse anti-thymocyte globulin (ATG) to the more immunosuppressive rabbit ATG, we now recommend use of irradiated blood components for aplastic anaemia patients receiving immunosuppressive therapy with ATG (and/or alemtuzumab) (2C). We cannot make a firm recommendation as to how long irradiated components should continue to be used after ATG administration. • Patients at risk of TA-GvHD should be made aware of their need for irradiated blood components and provided with appropriate written information and an alert-card for clinical staff. We endorse the recommendations from SHOT (http://www.shotuk.org) relating to improved clinical and laboratory awareness, documentation and communication of special requirements for transfusion, including irradiated components. Initiatives to improve laboratory and clinical information management systems (including IT links with Pharmacy and diagnostic services to highlight ‘at risk’ patients) should be incorporated into local policies and regularly audited. Poor communication between centres involved in ‘shared care’ of patients is a well-reported hazard and the development of a standardized national system for recording and transferring details of special transfusion requirements is an urgent requirement to improve patient safety. (2C). More detailed recommendations on ensuring special transfusion requirements are met are given in the BCSH Administration of Blood Components Guideline 2009 (http://www.bcshguidelines.com). Information leaflets for patients and healthcare staff are available from the UK Blood Services. Table I depicts a summary of the key recommendations. TA-GvHD is a very rare but usually fatal complication following transfusion of lymphocyte-containing blood components. Although the first reports concerned cases where viable allogeneic lymphocytes had been transfused into immunosuppressed recipients (von Fliedner et al, 1982; Burns et al, 1984; Anderson & Weinstein, 1990), it became apparent that non-immunosuppressed patients could also experience this problem, particularly if the blood components they received came from an HLA haploidentical unrelated donor or family member (Ohto et al, 1992; Aoun et al, 2003; Serefhanoglu et al, 2005; Triulzi et al, 2006; Agbaht et al, 2007). The risk associated with an individual transfusion depends on the number and viability of contaminating lymphocytes, susceptibility of the recipient’s immune system to their engraftment and degree of immunological (HLA) disparity between donor and patient. The minimum number of transfused lymphocytes necessary to provoke a GvHD reaction is unknown and may vary by clinical settings. Until recently, gamma irradiation of cellular blood components has been the mainstay of TA-GvHD prevention and practice was standardized in the UK following publication of the 1996 version of this BCSH Guideline (BCSH Blood Transfusion Task Force, 1996). TA-GvHD is a potential complication of transfusion of any blood component containing viable T lymphocytes when there is disparity in the histocompatibility antigens between donor and recipient. As well as the classical skin, gut and liver involvement seen in GvHD occurring after allogeneic stem cell transplantation, TA-GvHD is characterized by profound marrow hypoplasia and mortality in excess of 90% (Aoun et al, 2003; Williamson et al, 2007). There is a particular risk of TA-GvHD when the donor and patient share an HLA haplotype, as occurs within families (Petz et al,1993), or in populations with restricted haplotype diversity (Yasuura et al, 2000). In the Japanese population, the incidence of TA-GvHD is 10–20 times higher than in the North American Caucasian population. (Shivdasani et al,1993). The early features are fever, maculopapular skin rash, diarrhoea and hepatitis occurring 1–2 weeks after transfusion. Bone marrow involvement produces severe hypoplasia with profound pancytopenia. Diagnosis is usually made by biopsy of skin, gut or liver supported by evidence of persistence of donor lymphocytes. The presence of cells of donor origin may be demonstrated by polymerase chain reaction in peripheral blood (Utter et al, 2007) or short tandem repeat analysis using peripheral blood and skin biopsies from affected and non-affected sites in the patient, and peripheral blood samples from the implicated donors (Sage et al, 2005). Since its inception in 1996, the UK Serious Hazards of Blood Transfusion (SHOT) scheme has recorded 13 fatal cases of TA-GvHD (Stainsby et al, 2006; Taylor et al, 2009). Only two cases have been reported since the introduction of universal prestorage leucodepletion in the UK (Williamson et al, 2007) and no cases have been reported since 2001. Between 1996 and 2008, SHOT received reports of 405 cases where non-irradiated components had been transfused to high-risk recipients, many of whom had received the purine analogue fludarabine, but none developed TA-GvHD. This implies that prestorage leucodepletion has significantly reduced, if not abolished, the risk of TA-GvHD (Williamson et al, 2007). • All cases of transfusion-associated graft-versus-host disease (TA-GvHD) should be reported to the national haemovigilance system, as should all ‘near misses’ where non-irradiated components are transfused to high-risk patients without incident. (Grade 1 recommendation; level B evidence). The major technology for preventing TA-GvHD is irradiation of blood components to inactivate residual lymphocytes. Gamma rays and X-rays are similar in their ability to inactivate T lymphocytes in blood components at a given absorbed dose. Gamma-irradiators are expensive, and eventual decommissioning and disposal present significant difficulties. These highly radioactive cores may present a security risk in hospital settings. As the source decays, regular recalibration is required and irradiation time progressively increases. Dedicated X-ray blood irradiators are now available, have been widely used in North America for several years and are being introduced by the UK Transfusion Services. X-ray irradiation machines are less expensive and the absence of a radioactive source results in fewer regulatory requirements (Janatpour et al, 2005). Published data indicate that the small differences in red cell permeability found between X- and gamma-irradiated components are not clinically significant (Janatpour et al, 2005). Further work, commissioned by the Joint Professional Advisory Committee of the UK Transfusion Services on blood components irradiated using the Raycell X-irradiator, concluded that gamma and X-irradiation can be regarded as equivalent and both are suitable and safe for clinical use. • Gamma or X-irradiation of blood components, by validated systems, is the recommended procedure to prevent TA-GvHD. (Grade 1 recommendation; level B evidence). Studies using sensitive-limiting dilution assays indicate that a dose of 25 Gy, measured at the mid-plane of a component, completely abolishes mixed lymphocyte response (Pelszynski et al, 1994). The American Association of Blood Banks (AABB) recommends a dose of 25 Gy to the central area of the component with no portion receiving <15 Gy (AABB 2006). The Japanese Society of Blood Transfusion’s Guidelines recommend a similar dose (Asai et al, 2000). In the UK, a minimum of 25 Gy is recommended, but with the dose to any bag in the container not exceeding 50 Gy. To ensure this dose distribution is achieved, consultation with supporting physicists is mandatory. (Moroff & Luban, 1997; Moroff et al, 1997). • The minimum dose achieved in the irradiation volume should be 25 Gy, with no part receiving more than 50 Gy. (Grade 1 recommendation; level B evidence). Lymphocyte viability is retained in stored red cells for at least 3 weeks and TA-GvHD has been reported after transfusion of whole blood, red cells, platelets and granulocytes (Weiden et al, 1981). TA-GvHD has not been described following transfusion of frozen deglycerolized red cells, which are thoroughly washed free of leucocytes after thawing. TA-GvHD has not been described following transfusion of cryoprecipitate, fresh frozen plasma or fractionated plasma products, such as clotting factor concentrates, albumin and intravenous immunoglobulin. • For at-risk patients, all red cell, platelet and granulocyte components should be irradiated, except cryopreserved red cells after deglycerolization. It is not necessary to irradiate fresh frozen plasma, cryoprecipitate or fractionated plasma. (Grade 1 recommendation; level B evidence). Because of the sharing of HLA haplotypes, donations from family members pose a particular risk of TA-GvHD. Red cells, granulocytes, platelets and fresh plasma have all been implicated in TA-GvHD after transfusion from family members (Agbaht et al,2007), and there is an increased risk with donations from both first- and second-degree relatives. Several cases of TA-GvHD have been reported from Japan, where limited diversity of HLA haplotypes in the population increases the chance of a transfusion recipient receiving blood from a HLA haploidentical or HLA-identical donor (Ohto & Anderson, 1996). These observations are of relevance for patients receiving HLA-selected platelet concentrates from non-family members because of alloimmune refractoriness to random donor platelets. This would be expected to increase the risk of TA-GvHD, especially if the platelet donor is homozygous for one of the recipient HLA-haplotypes (analogous to donations within families or within racial groups of limited genetic diversity). A case of TA-GvHD in an immunocompetent recipient following transfusion of blood components from an unrelated HLA homozygous donor was recently reported (Triulzi et al, 2006), and four more cases were reported from Turkey in immunocompetent recipients who had received non-irradiated blood from relatives (Agbaht et al, 2007). The risk from HLA-selected platelets where the donor is not homozygous is uncertain. However, many transfusion centres now specifically maintain panels of homozygous donors for refractory patients, and in practice it is probably more reliable to recommend irradiation of all HLA-selected platelets, rather than risk the misallocation of some donations. • All transfusions from first- or second-degree relatives should be irradiated, even if the patient is immunocompetent (Grade 1 recommendation; level B evidence). • All HLA-selected platelets should be irradiated, even if the patient is immunocompetent. (Grade 2 recommendation; level C evidence). Undertaking irradiation of blood components constitutes a manufacturing process. The responsible department is therefore expected to comply with relevant aspects of the EC Guide to Good Manufacturing Practice (EudraLex 2010). Red cells can be irradiated up to 14 d after collection and stored for at least a further 14 d without significant loss of viability (Mintz & Anderson, 1993). Gamma irradiation may result in reduced post-transfusion red cell recovery after more prolonged storage, although recovery is still above the minimum acceptable 75% (Davey et al, 1992). Both gamma and X-irradiation of red cells result in accelerated leakage of potassium and an increase in the level of extracellular potassium (Moroff et al, 1999; Janatpour et al, 2005; Weiskopf et al, 2005). ‘Top-up’ transfusions given at standard flow rates do not constitute a risk of hyperkalaemia, even when given to premature neonates. Potassium load may be clinically important in rapid large-volume transfusions, such as neonatal exchange transfusion or intrauterine transfusion. Routine removal of supernatant plasma and washing of irradiated red cells is not considered necessary but, if this procedure is undertaken, the washed cells should be transfused as soon as possible, ideally within 3–4 h. Free haemoglobin levels are increased in stored irradiated red cell components (Weiskopf et al, 2005) but remain within acceptable limits. Irradiation has no clinically significant effect on red cell pH, glucose consumption, ATP or 2,3 DPG levels (Samuel et al,1997). • 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 from hyperkalaemia, e.g. intrauterine or neonatal exchange transfusion, it is recommended that red cells be transfused within 24 h of irradiation or that the cells are washed. (Grade 1 recommendation; level A evidence). Gamma irradiation below 50 Gy has not been shown to produce significant clinical changes in platelet function (Rock et al, 1988; Duguid et al, 1991; Sweeney et al, 1994). • Platelets can be irradiated at any stage during storage and can thereafter be stored up to their normal shelf life after collection. (Grade 1 recommendation; level A evidence). The evidence for irradiation damage to granulocyte function is conflicting, but in any case granulocyte products should be transfused as soon as possible after irradiation (Patrone et al, 1979; Haidenberger et al, 2003). • All granulocytes should be irradiated before issue and transfused with minimum delay. (Grade 1 recommendation; level C evidence). Radiation-induced malignant change. It is likely that the dose of gamma irradiation delivered to blood components significantly exceeds the lethal dose for such cells at high dose rates (3–4 Gy/min), resulting in complete cell death rather than transformation. Reactivation of latent viruses. Gamma irradiation can activate latent viruses and could theoretically result in transfusion-transmitted infection of the recipient (Ferrieu et al, 2003; Chou et al, 2007). No cases have been reported and the doses delivered significantly exceed those associated with such activation. Leakage of plasticizer. Leakage of plasticizer from the transfusion pack is a theoretical risk for recipients of large-volume transfusions of irradiated components (Rock et al, 1988), particularly for neonates. The effect of irradiation on the many new plastics and plasticizers potentially used in the manufacture of blood packs requires evaluation and monitoring. • Irradiated components not used for the intended recipient can safely be returned to stock to be used for recipients who do not require irradiated components. The reduction in shelf life must be observed. (Grade 1 recommendation; level B evidence). Irradiated components must be identified by an approved overstick label. The label should be permanent and include the date of irradiation and any reduction in shelf life. Approved bar code labels should be used. Assurance that components have been adequately irradiated is essential. Labels that are sensitive to irradiation and change from ‘NOT IRRADIATED’ to ‘IRRADIATED’ are commercially available. The dose at which the label changes to ‘IRRADIATED’ must be marked on the label. We recommend using a radiation-sensitive label on every pack irradiated. Batch control can also be performed using thermoluminescent dosimeters. The use of radiation-sensitive labels does not replace the need for regular and precise dosimetry. There should be a permanent record of all units irradiated, including details of irradiation batch and donation numbers, component type, the site of irradiation, when irradiation was performed and by whom. • All irradiated units should be labelled as such, using an approved bar code label. Each unit should be monitored using a radiation-sensitive device, and the result should be permanently recorded, manually or by computer. (Grade 1 recommendation; level C evidence). Neonates at risk of TA-GvHD. The newborn, especially if premature, may be at particular risk of TA-GvHD because of physiological immune incompetence. Donor lymphocytes may be found in the neonatal circulation 6–8 weeks after exchange transfusion (ET) (Hutchinson et al, 1971) and allogeneic cells have been detected after intrauterine transfusion (IUT) for haemolytic disease of the newborn and fetus (HDN) 2–4 years after transfusion in otherwise healthy newborns. Most cases of TA-GvHD reported in apparently immune competent infants have occurred in the setting of IUT followed by ET (Parkman et al, 1974), suggesting transfusion-induced tolerance or immune suppression. IUT alone. Despite the few reported cases of TA-GvHD following IUT alone from unrelated donors (Naiman et al, 1969), it is difficult not to recommend irradiation in the setting of a large-volume transfusion of fresh blood to a very immature recipient. IUT and subsequent exchange transfusion. Although reports are scarce, the published evidence supports a prudent policy of irradiation of blood for IUT and any subsequent ETs (Parkman et al, 1974). Exchange transfusion alone. Rare cases of TA-GvHD have been reported after ET alone in pre-term and term infants (Parkman et al, 1974; Harte et al,1997). On the balance of current evidence, irradiation of blood for ET in either pre-term or term infants is prudent but not mandatory. The risk of TA-GvHD must be balanced against those of any delay in transfusion while irradiation is performed. • All blood for intrauterine transfusion (IUT) should be irradiated. (Grade 1 recommendation; level B evidence). • Blood for neonatal exchange transfusion (ET) must be irradiated if there has been a previous IUT or if the donation comes from a first- or second-degree relative. (Grade 1 recommendation; level B evidence). • For other neonatal ET cases, irradiation is recommended provided this does not unduly delay transfusion. (Grade 1 recommendation; level C evidence). • For IUT and ET, blood should be transfused within 24 h of irradiation and, in any case, by 5 d or less from collection. (Grade 1 recommendation; level A evidence). Pre-term infants. Pre-term infants are often multiply transfused yet there are few reports of TA-GvHD (Ohto & Anderson, 1996). Full-Term infants. With increasing gestational age the ability of transfusions to induce tolerance decreases and the term or near-term infant seems capable of responding appropriately to transfused cells. Even in the setting of multiple transfusions associated with extracorporeal membrane oxygenation (ECMO), there has been only one reported case of TA-GvHD (Hatley et al, 1991), and these infants do not appear to be at especial risk. (Berger & Dixon,1989). • It is not necessary to irradiate red cells for routine ‘top-up’ transfusions of premature or term infants unless either there has been a previous IUT, in which case irradiated components should be administered until 6 months after the expected delivery date (40 weeks gestation), or the donation has come from a first- or second-degree relative. (Grade 2 recommendation; level C evidence). There have been no reported cases of TA-GvHD following platelet transfusion alone, but as platelets may contain small numbers of residual lymphocytes, the recommendations for red cell transfusion should also apply to platelets. Irradiation should be performed on platelets transfused in utero to treat alloimmune thrombocytopenia and on platelet transfusions given after birth to infants who have received either red cells or platelets in utero for 6 months after the expected delivery date. • Platelets transfused in utero to treat alloimmune thrombocytopenia should be irradiated and any subsequent red cell or platelet transfusions irradiated until 6 months after the expected date of delivery (40 weeks gestation). There is no need to irradiate other platelet transfusions for pre-term or term infants, unless they have been donated by first- or second-degree relatives. (Grade 1 recommendation; level C evidence). There have been no cases of TA-GvHD unequivocally attributed to granulocytes. However, because these components are heavily contaminated with lymphocytes and transfused extremely fresh, it is prudent to irrad" @default.
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W2058442870 title "Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force" @default.
W2058442870 cites W1482464940 @default.
W2058442870 cites W1606191931 @default.
W2058442870 cites W1635459483 @default.
W2058442870 cites W1979652617 @default.
W2058442870 cites W1979932898 @default.
W2058442870 cites W1986556678 @default.
W2058442870 cites W1989134387 @default.
W2058442870 cites W1990792476 @default.
W2058442870 cites W1992837814 @default.
W2058442870 cites W2000953014 @default.
W2058442870 cites W2004951924 @default.
W2058442870 cites W2007691149 @default.
W2058442870 cites W2009397598 @default.
W2058442870 cites W2013018809 @default.
W2058442870 cites W2020840388 @default.
W2058442870 cites W2023144407 @default.
W2058442870 cites W2023640756 @default.
W2058442870 cites W2034540522 @default.
W2058442870 cites W2038362945 @default.
W2058442870 cites W2040776379 @default.
W2058442870 cites W2041088942 @default.
W2058442870 cites W2043401912 @default.
W2058442870 cites W2051938180 @default.
W2058442870 cites W2069202531 @default.
W2058442870 cites W207432979 @default.
W2058442870 cites W2075034087 @default.
W2058442870 cites W2077226930 @default.
W2058442870 cites W2079670141 @default.
W2058442870 cites W2084006123 @default.
W2058442870 cites W2084245939 @default.
W2058442870 cites W2085615059 @default.
W2058442870 cites W2088099625 @default.
W2058442870 cites W2095359599 @default.
W2058442870 cites W2119239610 @default.
W2058442870 cites W2119466358 @default.
W2058442870 cites W2130981217 @default.
W2058442870 cites W2142007969 @default.
W2058442870 cites W2144165353 @default.
W2058442870 cites W2147854238 @default.
W2058442870 cites W2151152301 @default.
W2058442870 cites W2158446829 @default.
W2058442870 cites W2161998201 @default.
W2058442870 cites W2164271020 @default.
W2058442870 cites W2176497214 @default.
W2058442870 cites W2315831901 @default.
W2058442870 cites W2334062077 @default.
W2058442870 cites W2466997471 @default.
W2058442870 cites W4205319165 @default.
W2058442870 cites W4248853712 @default.
W2058442870 cites W4250976526 @default.
W2058442870 cites W51803984 @default.
W2058442870 cites W61714529 @default.
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