From the Research
Granulocyte transfusions should be administered daily for 3-5 consecutive days, with each transfusion lasting 1-2 hours, to provide temporary support for neutropenic patients with severe infections not responding to appropriate antimicrobial therapy. The decision to extend the duration of granulocyte transfusions should be based on clinical response, with the goal of resolving the infection or recovering neutrophil counts 1. Each transfusion should contain approximately 1-2 × 10^10 granulocytes collected from healthy donors, with a dose of at least 0.6 × 10^9 granulocytes per kilogram, as suggested by studies 2.
The transfusion should be administered through a standard blood filter at a rate of 2-4 mL/minute initially, which can be increased to 10-15 mL/minute if well tolerated. Premedication with acetaminophen, diphenhydramine, and sometimes corticosteroids (like hydrocortisone 100 mg IV) is recommended 30-60 minutes before transfusion to reduce febrile and allergic reactions. Patients should be monitored for adverse reactions including fever, chills, hypotension, respiratory distress, and transfusion-related acute lung injury.
Key considerations for granulocyte transfusions include:
- The short lifespan of transfused granulocytes (approximately 24 hours) necessitates daily administration until infection resolves or neutrophil counts recover 3.
- The use of G-CSF-primed granulocytes may improve the efficacy of granulocyte transfusions, particularly in patients with bacterial and fungal infections 4, 5.
- Disease status before granulocyte transfusion, such as complete or partial remission, and spontaneous recovery of the neutrophil count are significant predictors of control of infection 5.
Overall, granulocyte transfusions can be a valuable treatment option for neutropenic patients with severe infections, and their use should be guided by the latest evidence and clinical expertise 1, 2, 3, 4, 5.