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Review

Technetium Tc 99m Red Blood Cells

No authors listed
In: Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006.
.
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Review

Technetium Tc 99m Red Blood Cells

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Excerpt

Information in this record refers to the use of technetium Tc 99m red blood cells as a diagnostic agent. A US Nuclear Regulatory Commission subcommittee has recommended that nursing be discontinued for 24 hours after administration of all technetium Tc 99m diagnostic products to simplify guidance recommendations, although this time interval may be longer than necessary.[1] The International Commission on Radiological Protection recommend that breastfeeding should be interrupted temporarily after administration of in vivo labeled red blood cells but need not be interrupted after administration of in vitro labeled red blood cells (see table).[2] To follow the principle of keeping exposure "as low as reasonably achievable", some experts recommend nursing the infant just before administration of the radiopharmaceutical and interrupting breastfeeding for 6 hours after the dose, then expressing the milk completely once and discarding it. During the period of interruption, the breasts should be emptied regularly and completely. If the mother has expressed and saved milk prior to the examination, she can feed it to the infant during the period of nursing interruption.[3-5] The milk that is pumped by the mother during the time of breastfeeding interruption can either be discarded or stored refrigerated and given to the infant after 10 physical half-lives, or about 60 hours, have elapsed. Mothers need not refrain from close contact with their infants after usual clinical doses.[6]

Mothers concerned about the level of radioactivity in their milk could ask to have it tested at a nuclear medicine facility at their hospital. When the radioactivity is at a safe level, she may resume breastfeeding. A method for measuring milk radioactivity and determining the time when a mother can safely resume breastfeeding has been published.[7]

For nursing mothers who work with Tc 99m substances in their workplace, there is no need to take any precautions other than those appropriate for general radiation protection.[8]

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References

    1. Dilsizian V, Metter D, Palestro C, et al. Advisory Committee on Medical Uses of Isotopes (ACMUI) Sub-Committee on Nursing Mother Guidelines for the Medical Administration of Radioactive Material. Final report submitted: January 31, 2019. https://www.nrc.gov/docs/ML1903/ML19038A498.pdf
    1. Mattsson S, Johansson L, Leide Svegborn S, et al. Radiation dose to patients from radiopharmaceuticals: A compendium of current information related to frequently used substances. ICRP Publication 128. Annex D. Recommendations on breast-feeding interruptions. Ann ICRP. 2015;44(2) Suppl:319–21. - PubMed
    1. Mountford PJ, Coakley AJ. A review of the secretion of radioactivity in human breast milk: Data, quantitative analysis and recommendations. Nucl Med Commun. 1989;10:15–27. - PubMed
    1. Early PJ, Sodee DB. Principles and practice of nuclear medicine. 2nd ed. St Louis Mosby-Year Book, Inc 1995:1380-1.
    1. ARSAC notes for guidance: Good clinical practice in nuclear medicine. Notes for guidance on the clinical administration of radiopharmaceuticals and use of sealed radioactive sources. 2020. https://www.gov.uk/government/publications/arsac-notes-for-guidance - PubMed

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