Elsevier

Seminars in Hematology

Volume 44, Issue 1, January 2007, Pages 15-23
Seminars in Hematology

Granulocyte Transfusion: Current Status

https://doi.org/10.1053/j.seminhematol.2006.09.015Get rights and content

Infection associated with therapy-related neutropenia continues to be a major cause of morbidity and mortality. Renewed interest in granulocyte transfusion therapy as treatment for this condition has been generated by the observation that large doses of granulocytes can be obtained from donors who have been stimulated with granulocyte colony-stimulating factor (G-CSF). Granulocytes collected from these donors have been shown to effectively raise the patient’s neutrophil count and appear to function normally as judged both by in vitro and in vivo measures. The evidence for clinical efficacy is limited to that of case reports and small series, and the results are not uniform. Randomized controlled clinical trials are needed to determine whether this therapy is useful in either clearing infections or prolonging survival.

Section snippets

Granulocyte Procurement

Granulocyte donors are selected from pools of community apheresis donors, or, perhaps more commonly, from family members or friends of the patient. Donors should be ABO-compatible with the patient because of the relatively large number of red blood cells contained in a typical granulocyte concentrate. Infectious disease screening and testing is the same as with any blood product, but modifications are sometimes made in the timing of this testing to accommodate the need to transfuse the

Granulocyte Transfusion in the G-CSF Era

One reason for the marginal efficacy of traditional granulocyte transfusion therapy is the inadequacy of the cell dose ordinarily provided. Evidence for the importance of dose comes from several observations. First, in the early uncontrolled trials of granulocyte transfusion therapy, in which large doses of cells were obtained from donors with leukocytosis, clinical responses were reported to be dose-dependent. Morse et al25 observed that the increase in the patient’s neutrophil count was

Conclusion

Morbidity and mortality from neutropenia-related infection remain important clinical problems. The utility of high-dose granulocyte transfusion therapy in the treatment of these infections has been the subject of investigation for the last 20 years. Many studies have shown that G-CSF (±corticosteroids) stimulation of normal donors is well tolerated by donors and allows the collection of large numbers of neutrophils. These cells appear to function normally as determined by both in vitro and in

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