Leukocyte transfusions: Thinking twice

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There is convincing evidence that leukocyte transfusions have a definite, albeit restricted, role in managing profoundly neutropenic patients and certain rare patients with qualitative disorders of neutrophil function. Nonetheless, leukocyte transfusion techniques have yet to meet a number of important conceptual challenges of neutrophil replacement. Even with pharmacologic manipulation of leukocyte donors, current methods of leukapheresis cannot provide neutrophils in numbers that match the body's normal use and turnover of these cells. Neutrophils have also proved to be fragile cells in the blood bank, readily losing normal function with certain collection procedures and during short periods of storage. Moreover, transfused neutrophils that are unable to function and circulate normally in recipients can produce serious toxic reactions. In light of the marginal demonstrable benefits of leukocyte transfusions, potential toxicity is necessarily an important consideration in decisions to use this form of hematologic support. The fact that leukocyte recipients are usually extremely ill does not alter the physician's responsibility to avoid bringing harm to the patient without benefit.