Granulocyte Transfusion: Best Practice Collection & Transfusion

Abstract

Serious and repeated infections with bacteria, yeast, and fungus continue to be a consequence of severe neutropenia. Previous attempts to prevent and/or treat these infections in severely neutropenic patients through use of neutrophil (PMN) transfusions achieved only modest success – largely due to the collection and transfusion of relatively small numbers of PMNs. Granulocyte colony-stimulating factor (G-CSF) has revolutionized the collection of PMNs for transfusion because stimulation of donors with G-CSF plus corticosteroids before leukapheresis permits collection of 6–8 × 10 to the 10 PMNs per each transfusion. Although questions and concerns have been raised about the biology and potential toxicity of giving G-CSF + steroids to normal allogeneic donors, these issues have questionable clinical significance. Properly controlled, clinical trials have not been performed to evaluate the efficacy and toxicity of PMN transfusions collected from donors stimulated with G-CSF + steroids. Therefore, despite the somewhat compelling ‘logic’ that transfusing very high numbers of PMNs should be helpful in treating serious infections in neutropenic patients, this practice can not be justified at this time. Indeed, published reports of individual patients and small series of patients have given mixed results (i.e., successes and failures). Hence, the need for properly-designed clinical trails.