Blood transfusion granulocytes

Sterilization of the gastrointestinal tract by nonabsorbable antibodies may reduce the possibility of infection from enteric organisms. Bone marrow transplants or blood transfusions may be indicated. The recent introduction of granulocyte colony stimulating factor may offer hope in the management of bone marrow depression. 

Observational studies In a study of 30 patients who received pooled, whole blood-derived granulocytes in additive solution and plasma, authors report one transfusion-associated circulatory overload and three patients developed new leucocyte alloimmunisation [23 ]. 

Jereb M, Pecaver B, Tomazic J, Muzlovic 1, Avsic-Zupanc T, Premru-Srsen T, et al. Severe human granulocytic anaplasmosis transmitted by blood transfusion. Emerg Infect Dis 2012 18(8) 1354-7. 

Original suggestions that DAMB in combination with granulocyte transfusions (78) result in pulmonary toxicity have subsequently not been confirmed in prospective observations (62,79). Pulmonary reactions, including dyspnea, hemoptysis, and new infiltrates, have also been suspected to be caused by the combined use of blood platelet transfusions and DAMB (SEDA-12, 227). It therefore appears advisable to space transfusions of blood products and amphotericin if possible (80). 

Weiden PL, Zuckerman N, Hansen JA, Sale GE, Remlinger K, Beck TM, Buckner CD. Fatal graft-versus-host disease in a patient with lymphoblastic leukemia following normal granulocyte transfusion. Blood 1981 57(2) 328-32. 

McCullogh J. The clinical significance of granulocyte antibodies and in vivo studies of the fate of granulocytes. In Garratty G, editor. Current Concepts in Transfusion Therapy. Arlington, VA American Association of Blood Banks, 1985 125. 

Vij R, Adkins DR, Brovm RA, Khoury H, DiPersio JF, Goodnough T. Unstable angina in a peripheral blood stem and progenitor cell donor given granulocyte-colony-stimulating factor. Transfusion 1999 39(5) 542-3. 

All vesicant-exposed patients should have a CBC performed daily. Treatment of bone marrow suppression should include infection precantions, transfusions, and aggressive treatment of infections as indicated (3). Smdies indicate that granulocyte colony-stimulating factor (GCSF) may be usefnl for bone marrow suppression secondary to nitrogen mustard exposure (25,26). Bone marrow transplantation may be useful, but evidence is limited. Any mustard-exposed patient with a marked decrease in white blood cell count requires reverse isolation in an oncology or bnm unit (25,26). 

IL-2, with or without leukapheresis and reinfusion of lymphokine-activafed killer cells, has been used in the treatment of solid fumors such as metastatic melanoma, metastatic renal cell carcinoma, and colorectal carcinoma. Unless bacterial or viral contamination is inadvertently introduced at the time of cell culfure, lymphokine activated killer cell infusion is associated with only minor side effects of mild chills and fever and occasional dyspnea or bronchospasm similar to that seen with granulocyte transfusion reactions [35]. IL-2 infusions are associated with significant dose-de-pendent toxicity characterized by fevers, malaise, nausea, vomiting, diarrhea, hepatic dysfunction, pulmonary edema, somnolence, confusion, dysrhythmias, myocardial infarction, hematopoietic suppression, and renal insufficiency [35]. IL-2 appears to cause a generalized increase in capillary permeability, reduced systemic vascular resistance, fluid shifts and low effective circulating blood volume. It is not known if fhe vascular effects are a direct effect of IL-2 or due to IL-2 induced release of other mediators such as interferon (IFN), IL-1, TNF-a, and lymphofoxin [36, 37]. 

Massey E, Harding K, Kahan BC, Llewelyn C, Wynn R, Moppett J, et al. The granulocytes in neutropenia 1 (GIN 1) study a safety study of granulocytes collected from whole blood and stored in additive solution and plasma. Transfus Med 2012 22(4) 277-84. 

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