SUPPORTIVE CARE OF CHILDREN WITH CANCER AND BLOOD COMPONENT THERAPY: GRANULOCYTE TRANSFUSION

A.     Definition of granulocytopenia

Significant granulocytopenia results in an increased risk of bacterial and fungal infection. The risk increases dramatically as the absolute granulocyte count decreases below 200/pL.

B.     Granulocyte preparations

Granulocytes collected by discontinuous- or continuous-flow centrifugation have better function (chemotaxis, phagocytosis, degranulation, killing, and migration to sites of infection) and fewer side effects (fever, chills, and hypotension) than white cells collected by filtration leukapheresis.

C.     Specific risks of granulocyte transfusion

There are particular risks of CMV infection, graft-versus-host disease, respiratory distress with pulmonary infiltration, alloimmunization, and hemolytic reactions associated with granulocyte transfusion.

D.     Options for the correction/prevention of granulocytopenia

1.     The use of granulocyte transfusion has not been proven

of significant benefit except for patients with severe neutropenia and gram-negative septicemia or systemic fungal

infection.

a.     Circulating granulocytes have a half-life of 6-10 hours;

b.     Granulocytes obtained from ABO/Rh-compatible, HLA-

matched, lymphocytotoxicity-negative, neutrophil-

antibody-nonreactive donors appear to be the most

effective.

2.     The use of granulocyte-colony-stimulating factor or other     cytokines has markedly decreased the use of granulocyte

transfusion.

E.     Dose of granulocyte transfusion

The dose of granulocytes is generally > 1 x 1010/m2 granulocytes.

It is preferable to use Rh-matched granulocyte units for females; ABO compatibility is recommended for all patients. If using single-donor apheresed granulocytes with an anti-A or anti-B titer > 1:64 for an A, B, or AB recipient, remove the plasma.

F.     Indications for granulocyte transfusion. All of the following

Severe neutropenia [absolute neutrophil count (ANC) < 100/pL] and serious bacterial or fungal infection that is culture-positive or deep-seated and persists > 48 hours despite appropriate antibiotic coverage.

The ANC is not expected to increase to > 500/uL for several days and prolonged survival is expected if the infection is controlled.

G.     Additional indications for granulocyte transfusion may

include patients with severe granulocyte dysfunction (e.g., chronic

granulomatous disease) with life-threatening infection.

H.     Administration

Administer through a 170-p filter at a rate of 150 mL/m2/n as soon after collection as possible.

If not used immediately, store at room temperature.

Do not administer with a leukocyte-depleting filter.

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Cancer