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Granulocyte concentrates contain granulocytes (≥1×1010) that have been obtained from a single donor using apheresis and are suspended in plasma; they also contain various other cells, including other types of white blood cells, red blood cells, and platelets. A small amount of artificial colloids (hetastarch [hydroxyethyl starch] or other) is also present in the product. When necessary, granulocyte concentrate may be stored at 20 to 24 degrees Celsius for up to 24 hours from the completion of apheresis. All granulocyte transfusions require irradiation.
IndicationsTop
Minimal criteria for granulocyte concentrate transfusion (regardless of the cause of neutropenia):
1. Prolonged agranulocytosis, that is, absolute neutrophil count (ANC) <500 cells/microL if resolution is not expected in the short term, or abnormal granulocyte function (like in chronic granulomatous disease).
2. Evidence of bacterial or fungal infection (ie, clinical symptoms of infection, positive cultures, pathologic diagnosis of infection from biopsies, radiographic evidence of pneumonia).
3. Nonresponsiveness to antimicrobial treatment given for ≥48 hours.
Granulocyte concentrate effectiveness has not been demonstrated. This product is not routinely stored in hospital blood banks. Prophylactic use of granulocyte concentrate is not recommended. Transfusions should be continued daily until bone marrow function returns or control of infection is achieved; transfusions should also be discontinued if no improvement is seen despite appropriate doses of granulocyte concentrate or if serious adverse effects occur.
ProcedureTop
Granulocyte concentrate should be administered immediately after its delivery to the ward using a standard transfusion set with a microaggregate filter. The daily dose of granulocytes in adults and children is 1.5 to 3×108/kg of body weight (in neonates ≥1×109/kg of body weight).
ComplicationsTop
Transfusion reactions occur in 25% to 50% of cases and are mostly mild to moderate in severity (fever and chills). Slow infusion and premedication with acetaminophen [INN paracetamol] and diphenhydramine can reduce these adverse effects. Other complications include pulmonary adverse reactions, transfusion-associated graft-versus-host disease (Ta-GVHD), human leukocyte antigen (HLA) alloimmunization, and transfusion-transmitted infection.
