A 62-year-old man with chronic lymphocytic leukaemia is about to start fludarabine-based chemotherapy and will need regular red cell and platelet transfusions. Which special requirement applies to all his future cellular blood components?

• A Leucodepletion only
• B Gamma irradiation of all cellular components ✓
• C CMV-seronegative components only
• D Washing of all components to remove plasma proteins

Explanation

Fludarabine and similar purine analogues cause profound, long-lasting T-lymphocyte depletion, placing the patient at high risk of transfusion-associated graft-versus-host disease (TA-GVHD), which is almost uniformly fatal. Irradiating all cellular components inactivates donor T lymphocytes and prevents this. Leucodepletion does not remove enough lymphocytes to prevent TA-GVHD. CMV-negative components address CMV transmission, not GVHD, and washed components address recurrent allergic reactions. Hodgkin lymphoma, allogeneic and autologous marrow transplant recipients, and intrauterine transfusions carry the same requirement.

Reference: Schwartz's Principles of Surgery, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.