Abstract:
Introduction: Granulocyte transfusions are requested to treat severely neutropenic adult/pediatric Leukemic and Stem cell transplant patients with overwhelming bacterial/fungal infections. Clinical indications range from organ specific to soft tissue infections infection.
Requesting Granulocytes: The process begins when the patient’s primary team notifies the White Blood Cell Nurse Coordinators at the Blood Donor Center. Education material (Overview and Donor Process) with a link to a video presentation is forwarded to the donors. The eligibility and collection is a three-day process and logistics can be complicated as the donors may not always be available when the transfusion is needed. All donors (family, friend, relatives and volunteers) are eligible to be prescreened and consented for granulocyte apheresis.
Donor Eligibility: Donors are required to be eligible as per FDA/AABB guidelines, ABO compatible with the patient and female donors negative for HLA antibodies. If the patient has a red cell alloantibody, the designated donor is screened for the cognate antigen. CMV testing is not performed, and HLA compatible granulocytes are currently not available. All prescreened eligible donors are required to undergo a platelet apheresis collection prior to granulocyte collection. Medical exceptions are made when the patient and the care team agrees to an ABO incompatible transfusion. After the platelet apheresis, the donor is notified by the Transfusion Medicine Physician. The nurses schedule the donor for pickup of G-CSF and Dexamethasone a day prior to the apheresis procedure. All donors are stimulated with 480 mg granulocyte colony stimulating factor (G-CSF) and 8 mg dexamethasone the night before the apheresis with few exceptions. At the time of medication pick up a second CBC, repeat Infectious disease testing is done, and vital signs documented.
Granulocytapheresis: The apheresis procedure may take up to 180 minutes depending on TBV, increment in WBC after stimulation and is optimized to reduce red cell collection. All units are drained by gravity with or without the addition of Hetastarch. A complete blood count is performed on each unit to obtain the unit wbc count and volume of donor red cells. The irradiated/labelled granulocyte unit(s) are available for transfusion approximately 3 hours after collection, stored at room temperature 22 C and expire 24 hours from the time of completion. A large unit dose may be split to support more than one patient. The Blood Donor center can perform Granulocytapheresis daily if there are eligible prescreened donors available.
Administration of Granulocytes: Compatibility testing is performed on all units. Granulocytes are transfused via a red cell infusion set not to exceed 4-hours. Patient response is monitored by treating team and the WBC nurse coordinators daily. The clinical decision to continue, stop or pause the transfusion is at the discretion of the primary care team.
Outcome: Our Blood Donor Center has performed 1530 granulocyte apheresis procedures since Dec 2015 to March 2023, the majority (63%) being male donors, median age 41 years (range 17-83), unit volume median 631 mL (229-1085) and Unit WBC median 10.3 10e10 (range 2.46-33.06) and continues to be a successful treatment modality.
