Granulocyte Transfusion

Granulocyte concentrates are prepared from a single donor by centrifugal leukapheresis. Each unit contains 1 to 5 X 1010 granulocytes, 0.2 to 1.5 X 1010 lymphocytes, 1 to 10 X 1011 platelets, and 25 to 50 mL of red blood cells suspended in 200 to 500 mL of plasma.

Normal donors stimulated with corticosteroids often do not yield more than 1 x 1010 granulocytes in a single donation. Units collected from donors stimulated with 300-600 ug of sc G-CSF and 8 mg of oral dexamethasone 8 to 24 hours prior to leukapheresis regularly yield 7 x 1010 granulocytes. Transfused granulocytes have normal chemotactic and phagocytic functions, and transfused monocytes retain the ability to differentiate into macrophages.

Granulocytes begin to lose function in less than 6 hours after collection. Granulocyte concentrates outdate 24 hours after collection. Concentrates should be infused through a standard blood filter over 2 to 4 hours. Units must be ABO and Rh compatible because of the significant number of red blood cells present in the concentrate. Granulocyte units should be irradiated immediately prior to transfusion. They should not be transfused through a leukocyte reduction filter. Post transfusion granulocyte counts do not reflect therapeutic effect. The patients' symptoms should be followed as an indicator of clinical improvement.

Indications for Granulocyte Transfusions
Enthusiasm for granulocyte transfusion has waxed and waned and, in recent years, their use has decreased. Nevertheless, they may play a role in selected patients with severe neutropenia and sepsis unresponsive to antibiotics. Clinical indications for granulocyte transfusions include:

Bacterial or fungal infection unresponsive to 48 hours of appropriate antibiotic therapy in the presence of bone marrow hypoplasia and absolute neutropenia (< 500 /uL).
Bacterial infection or disseminated progressing fungal infection in the setting of severe granulocyte dysfunction such as in chronic granulomatous disease.
Neonates with bacterial sepsis and bandemia of >70% and neutropenia < 300/uL during the first week of life or < 100/uL after the first week of life.

An acceptable therapeutic dose is a minimum of 1x1010 , preferably closer to 1011, granulocytes per day. Patients usually need to be infused daily for several days until their symptoms of infection improve or their absolute neutrophil count increases above 500 for more than 48 hours. The dose for neonatal granulocyte transfusions is 15 mL/kg, which is approximately 0.75 to 1.0 x 109 granulocytes.

The majority of patients with newly diagnosed acute leukemia that experience successful induction chemotherapy will respond to antibiotics alone and will not require granulocyte transfusion. However granulocyte transfusions may be beneficial in septic patients with severe neutropenia who have failed a reasonable course (approximately 48 hours) of combination antibiotics. It seems logical, although unproven, that patients with evidence of alloimmunization (platelet refractoriness, anti-granulocyte antibody, or repeated febrile transfusion reactions) should receive granulocyte transfusions from donors selected to be as leukocyte compatible as possible by HLA-matching and/or leukocyte cross-matching .




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