CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Karen Titus
June 2017—For laboratories and blood centers, thinking about safety is second nature, like rain in Seattle or sunshine in San Diego. Everyone understands the need to prevent transfusion-associated graft-versus-host disease, and standards, protocols, and habits have settled in to ensure a safe blood supply.
Creating a product safe from TA-GvHD means relying on blood product irradiators, either cesium or x-ray. “They’re like any other piece of laboratory equipment,” says Karen Nelson, PhD, vice president of laboratories, Bloodworks Northwest, a Seattle-based blood center and research institute. To decide which machine is best, “You have to look at the cost-benefit ratio, and what cost it adds to each procedure that you do.” Cesium irradiators are boringly reliable; x-ray irradiators don’t share that same reputation for consistency. X-ray irradiators can fit in almost anywhere in the laboratory, while cesium irradiators must dwell in their own carefully secured rooms.
Institutions that have continued to use cesium irradiators, however, have one more element to think about. In the post-9/11 era, when ensuring a safe blood supply has just as much to do with thinking about terrorism (and possibly other types of attacks) as it does reducing viable leukocytes in the blood component, they have to decide whether it makes sense to replace a cesium irradiator with an x-ray device. The risk of a terrorist attack on a blood center may be low, but it’s a risk nonetheless.
The specter of a terrorist attack raises the stakes of this decision significantly. The patient population quickly becomes the population of a city or region. And laboratory safety means figuring out how to protect staff when a SWAT team bursts through the doors.
In Seattle, three blood experts who have followed the debate weighed in with CAP TODAY. (The first CAP TODAY article on the topic, “New rays on blood safety,” appeared in the March issue.) As they each made clear, grappling with safety issues means thinking outside the locked box.
At most institutions, the type of irradiator in use is weighted in history. New irradiators are expensive (a quarter of a million dollars on the low end, plus costly annual service contracts), and a why-change-what’s-always-worked attitude makes even more sense given that cesium irradiators, with their long-lived, Dorian Gray-like source, do, in fact, always seem to work.