From the Guidelines
Infused neutrophils can lead to significant complications, including transfusion-related acute lung injury (TRALI), febrile non-hemolytic transfusion reactions, allergic reactions, transfusion-associated circulatory overload, bacterial contamination, alloimmunization, and inflammatory responses, which can worsen morbidity and mortality. According to a recent Cochrane review [@180@], there is no mortality difference for any kind of infection in patients with neutropenia who receive granulocyte transfusions, highlighting the need for careful consideration of the risks and benefits of neutrophil infusions. Some of the potential complications of infused neutrophils include:
- Transfusion-related acute lung injury (TRALI)
- Febrile non-hemolytic transfusion reactions
- Allergic reactions
- Transfusion-associated circulatory overload
- Bacterial contamination
- Alloimmunization
- Inflammatory responses These complications can be managed with careful patient monitoring, premedication with antipyretics or antihistamines when indicated, and using leukoreduction filters to minimize adverse reactions 1. Neutrophil transfusions should be reserved for specific clinical scenarios where benefits outweigh these potential risks, such as in patients with severe neutropenia and life-threatening infections. In such cases, the use of granulocyte colony-stimulating factor (G-CSF) or G-CSF-primed granulocyte infusions may be considered as an adjunctive therapy, although the evidence for its effectiveness is limited and based on anecdotal data mainly from pediatric populations 1. Overall, the decision to infuse neutrophils should be made on a case-by-case basis, taking into account the individual patient's risk factors, clinical condition, and potential benefits and risks of the treatment.
From the Research
Complications of Infused Neutrophils
- Infused neutrophils can lead to graft-versus-host disease (GVHD) after bone marrow transplantation, particularly if cyclosporine concentrations are low 2
- Tumor-associated neutrophils (TAN) can promote cancer progression by suppressing adaptive immune cells, such as cytotoxic T lymphocytes 3, 4
- Neutrophils can also contribute to cancer metastasis, immunosuppression, and angiogenesis 4
- Elevated neutrophil to lymphocyte ratios may indicate a poor prognosis in cancer patients and suggest neutrophils as a potential therapeutic target 4
- Neutrophils can modulate the adaptive immune response by interacting with dendritic cells and lymphocytes, and producing cytokines 5
- Neutrophil heterogeneity, with different functional phenotypes, has been described in cancer and inflammation, highlighting the complexity of their role in the immune system 5