A granulocyte transfusion is a medical procedure in which
neutrophils), but the practice declined in popularity in the 1980s. Interest in the procedure increased in the 1990s due to the development of more effective methods for harvesting granulocytes and a growing population of people with severe neutropenia from chemotherapy. However, the treatment's efficacy remains poorly understood and its use is controversial.[1][2][3]
G-CSF that stimulate the production of neutrophils in the bone marrow.[6] However, another approach is to directly transfuse granulocytes from a donor into the person's blood.[1]
As of 2015, there is some evidence that granulocyte transfusions may help to prevent
Granulocyte transfusion is still used in some cases, such as when a person has severe neutropenia and an infection that is life-threatening or does not respond to
antimicrobial treatment.[1] The treatment has also been studied in people with aplastic anemia (a condition in which a person's bone marrow does not produce enough blood cells) and chronic granulomatous disease (a disorder in which a person has a normal number of neutrophils, but they do not function correctly). Newborn babies who have neutropenia and sepsis are sometimes given granulocyte transfusions,[1] although a 2011 study found that there was insufficient evidence to determine whether or not this practice is effective.[9]
Donation
Prior to donating granulocytes, potential donors must undergo screening and testing procedures. They are required to meet the general criteria for
In order to collect enough granulocytes for the transfusion to be effective, donors are frequently given drugs to increase their neutrophil count prior to the blood collection. The treatment typically includes
chronic myeloid leukemia, a disease that causes a very high neutrophil count.[2][10]: 627 Donors may experience minor side effects from steroid and G-CSF treatment, including headaches, bone and joint pain, insomnia and fatigue.[1] During the blood collection, the donor's blood is mixed with hydroxyethyl starch, which helps separate the granulocytes from other blood components during sample processing.[1][11]
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The donor blood undergoes
red blood cells and plasma. The other components of the blood are returned to the donor's circulation.[11]: 297 The process of collecting the granulocytes takes about four to five hours.[1] Because a large amount of blood (seven to ten litres) is processed during apheresis, donors may experience adverse effects from changes in fluid balance.[3] An alternative approach, more commonly used in the United Kingdom, is to combine the buffy coats (the fraction of blood containing white blood cells) from multiple routine blood donations to create a blood product containing a high amount of granulocytes.[12]
Once collected, granulocytes have a 24-hour shelf life.
T lymphocytes, which can cause graft-versus-host disease in the recipient, so it is often exposed to radiation to inactivate these cells.[10]
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Risks
chest X-rays.[1] These lung complications may potentially be fatal.[2] A review paper found that the frequency of lung-related side effects ranged from 0 to 53 percent.[13]
Recipients can develop
pathogens are present in the donor blood, which is a particular problem with granulocyte transfusions because of their short shelf life, which means they must be transfused before infectious disease testing is complete.[1] Infection with cytomegalovirus (CMV) is a concern, as this virus is found in white blood cells, so if the recipient is at risk of developing severe disease from CMV, it is recommended that granulocytes be collected from a CMV-negative donor.[2]
If the donor white blood cells are not irradiated, the recipient may be at risk of developing
In a 1934 experiment, Strumia gave neutropenic patients
multidrug resistant infections, led to a renewal of interest in granulocyte transfusions.[3]
Notes
^If an ABO-compatible donor cannot be found, then the unit of granulocytes can undergo further processing (before being administered to the patient) in order to remove red blood cells.[10]: 630
