Principles of Neutrophil (Granulocyte) Transfusions

Published on 04/03/2015 by admin

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Last modified 04/03/2015

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Chapter 51 Principles of Neutrophil (Granulocyte) Transfusions

Ronald G. Strauss

Table 51-1 Infectious Problems in Neutropenic Patients Treated With Historical Granulocyte Transfusions in 34 Studies

Collection and Transfusion of Neutrophil Concentrates

To ensure adequate numbers and quality of polymorphonuclear neutrophils (PMNs) for transfusion, PMNs must be collected from stimulated donors by automated leukapheresis using an erythrocyte sedimenting agent, such as hydroxyethyl starch. A major limitation of granulocyte transfusion (GTX) efficacy has been the inability to transfuse adequate numbers of perfectly functioning PMNs. Under the stress of a severe bacterial infection, the marrow of an otherwise healthy adult will produce between 10¹¹ and 10¹² PMNs in 24 hours. Granulocyte concentrates collected from healthy donors who are not stimulated with corticosteroids or granulocyte colony-stimulating factor (G-CSF) will contain between 0.2 and 0.8 × 10¹⁰ PMNs—a woeful number equal to approximately 1% of a healthy marrow’s output. Hence donor stimulation is mandatory to achieve even a hope of a reasonable PMN dose per GTX.

Donor stimulation using only properly timed corticosteroids (≥24 hours before leukapheresis, NOT immediately before) will increase the yield to approximately 2 × 10¹⁰ PMNs. Stimulation with G-CSF, alone or in combination with corticosteroids, will produce higher but variable PMN yields. Yields of 4 to 8 × 10¹⁰ PMNs are achieved regularly, and posttransfusion blood PMN counts frequently increase to 1 to 3 × 10⁹

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