Granulocyte transfusion

J. P. Dutcher, "Granulocyte Transfusions in Patients with Malignancy," in Ref 5. 

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). 

Dutcher JP, Kendall J, Norris D, Schiffer C, Aisner J, Wiemik PH. Granulocyte transfusion therapy and... 

Complications after granulocyte transfusions occur in about 15-20% of the recipients (38), most frequently in patients given granulocytes prepared by filtration leukapheresis. The complications are predominantly severe febrile reactions, the transmission of cytomegalovirus infection, and graft-versus-host disease. Of particular importance are respiratory reactions with pulmonary edema, which mostly occur in allo-immunized recipients. Leukocjrte aggregation may be the cause, with sequestration microemboli and fluid overflow, but other causes have also been suspected. Reactions appear to be more common in patients with sepsis. 

Karp DD, Ervin TJ, Tuttle S, Gorgone BC, Lavin P, Yunis EJ. Pulmonary complications during granulocyte transfusions incidence and clinical features. Vox Sang 1982 42(2) 57-61. 

McCullough J, Clay M, Loken M, Hurd D. Effect of ABO incompatibility on the fate in vivo of indium granulocytes. Transfusion 1988 28(4) 358-61. 

Ritchey AK, Andiman W, McIntosh S, Berman B, Luce D. Mononucleosis syndrome following granulocyte transfusion in patients with leukemia. J Pediatr 1980 97(2) 267-9. 

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. 

Seidl S, Khp M. The current status of platelet and granulocyte transfusions. Haematologia (Budap) 1980 13(l ) 145-54. 

The authors stressed the recurrence of the disorder after each of the three granulocyte transfusions that the patient had received and suggested that adverse effects might occur after transfusion performed with G-CSF-mobilized granulocj4es, even though the patient has not been given G-CSF. 

The use of adjuvant therapies, such as granulocyte transfusions or recombinant colony-stimulating factors, remains controversial, and controlled trials are lacking at this time. Although some authors advocate combination therapy with azoles, flucytosine, or rifampin plus amphotericin B, controlled clinical studies verifying the efficacy of these combination therapies are lacking. 

Strauss RG (1995). Clinical perspectives of granulocyte transfusion efficacy to date. J ClinApheresis, 10, 114-118. 

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]. 

Treatment of infection antibiotic, anti-viral and anti-fungal therapy, adjuvants including cytokines, immunoglobulins and granulocyte transfusions. 

Neutropenia is a common adverse effect of the cytotoxic drugs used to treat cancer and increases the risk of serious infection in patients receiving chemotherapy. Unlike the treatment of anemia and thrombocytopenia, transfusion of neutropenic patients with granulocytes collected from donors is performed rarely and with limited success. The introduction of G-CSF in 1991 represented a milestone in the treatment of chemotherapy-induced neutropenia. This growth factor dramatically accelerates the rate of neutrophil recovery after dose-intensive myelosuppressive chemotherapy (Figure 33-5). It reduces the duration of neutropenia and usually raises the nadir count, the lowest neutrophil count seen following a cycle of chemotherapy. 

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. 

A 53-year-old man with aplastic anemia had clinically asjmptomatic and reversible hypercoagulability after the transfusion of granulocytes obtained from G-CSF-stimulated donors (46). 

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. 

Mizuno S, Okamura T, Iwasaki H, Ohno Y, Akashi K, Inaba S, Niho Y. Hypercoagulable state following transfusions of granulocytes obtained from granulocyte colony-stimulating factor-stimulated donors. Int J Hematol 2000 72(1 ) 115-17. 

Neumanaitis J. Granulocyte-macrophage-colony-stimulatmg factor a review from preclinical development to clinical apphcation. Transfusion 1993 33(l) 70-83. 

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. 

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). 

Hubei K, Dale DC, Engert A, Liles WC. Current status of granulocyte (neutrophil) transfusion therapy for infectious diseases. J Infect Dis 2001 183 321-328. 

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 ]. 

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