Granulocyte Concentrates

Granulocyte (neutrophil) concentrates are obtained from volunteer donors using a leukapheresis procedure following dexamethasone stimulation. Granulocyte concentrates are available only through consultation with a transfusion medicine physician.

Volume: 150-300 mL
Contents: A unit contains 1.5 to 4 X 1010 granulocytes, with red cells and lymphocytes

Storage: Granulocytes expire after 24 hours

Dose: The dose is a single granulocyte transfusion per day. A dose is given daily until granulopoiesis returns, the infection is controlled, the patient is moribund, or a contraindication develops

Indications for Granulocyte Concentrate Transfusion

1. Life threatening bacterial or fungal infection in patients with neutropenia as documented by ALL of the following: 

a. Absolute neutrophil count less than 1000/uL in neonates or less than 500/uL (usually less than 100/uL) in adults
b. Evidence of progressive infection shown by any of the following: 

◦Fever greater than 38.5 C for greater than 48 hours
◦ Positive internal site cultures
◦ Progressive soft tissue lesions
◦ Progressive pulmonary infiltrates
◦ Documented disseminated fungal infection
c. Broad-spectrum antibiotics or pathogen specific therapy has been given without clinical response.
d. There must be a reasonable expectation for recovery of the patient’s neutrophil count.

2. Life threatening infection in patients with granulocyte dysfunction (e.g., chronic granulomatous disease unresponsive to antibiotics)

3. The use of granulocyte transfusions is restricted to severely neutropenic patients with marrow failure that is not expected to return to normal granulopoiesis in the near future. Granulocyte transfusions are not needed in infected patients with antibody-mediated immune neutropenia with a normal marrow whose severe neutropenia is due to rapid destruction of granulocytes.

4. The number of granulocytes in a granulocyte transfusion is only a fraction of that produced and released daily by the marrow of a healthy non-infected person. Granulocyte transfusions can be a supportive addition in selected severely neutropenic patients with marrow failure and bacterial sepsis when the usual therapy of antibiotics and drainage, etc. has failed. Most cases of bacterial sepsis in severely neutropenic patients respond to antibiotic therapy and granulocyte transfusions are rarely needed. Granulocyte transfusions should not be considered unless there is no response for at least 48 to 96 hours after initiating antibiotics. The effectiveness of granulocyte transfusions in fungal disease has not been proven.

5. Granulocyte transfusions should not be infused at the same time as infusions of medications that have a high incidence of causing adverse reactions (e.g., amphotericin B, intravenous immune globulin, Campath, IL-2, ATG). Granulocytes can be given without delay immediately before or after amphotericin B.

6. Adverse reactions occur more commonly with granulocyte transfusions. Monitor the patient closely and report all transfusion reactions.

7. Granulocyte donations have significantly more risks for the donor than other blood donations and these risks should be considered when weighing the risk and benefit prior to ordering the transfusion.

8. Because of a rapid decline in granulocyte function during storage, granulocyte concentrates must be transfused within 24 hours of donation. Blood donor infectious disease testing is not completed by the time of transfusion.

9. Cytomegalovirus (CMV) is readily transmitted by granulocyte transfusion. CMV negative components will be provided for CMV negative recipients when available. If the patient’s CMV status is unknown, a specimen should be obtained for CMV antibody testing prior to the first transfusion.