Chapter 16 - Granulocyte Transfusions in the Neonate and Child

Abstract

This chapter reviews the normal physiology of myelopoiesis; definitions of neutropenia in the neonate and child; indications for granulocyte transfusions in the child; methods of mobilization, collection, and functionality of allogeneic granulocytes for transfusion; and dosing administration and side effects of allogeneic granulocyte transfusions. Unmobilized allogeneic granulocyte transfusions in neonates, children, and adults with severe neutropenia and sepsis are associated with mixed success. Recently, it was demonstrated that the mobilization of allogeneic donors with dexamethasone and granulocyte-colony stimulating factor (G-CSF) before apheresis has significantly increased the yield of neutrophils by five- to ten-fold. Whether the use of higher doses of mobilized allogeneic donor granulocytes will significantly increase the survival rate of neutropenic septic neonates and children is yet to be found out. Future prospective multicenter randomized trials will be required to accurately assess whether an increased granulocyte dose following mobilization of granulocyte donors will significantly improve survival compared to unmobilized granulocyte transfusions in severely neutropenic and septic children.