Ten severely burned (greater than 50% BSA) pediatric and young adult patients developed 19 episodes of clinical sepsis of four or more days duration. During eight of the 19 septic episodes the patients received granulocyte transfusions (median, four; range, two to seven). Risk variables, types and prevalence of infections, mainly Pseudomonas aeruginosa and antibiotic regimens were similar for all the septic episodes studied. All eight episodes (100%) resolved in the transfused group while eight of 11 (72%) episodes resolved in the nontransfused group. Patients survived four episodes of ecthyma gangrenosum when granulocyte transfusions were used and the single episode in which they were not used was fatal. Granulocyte transfusions may be helpful in severely burned patients with sepsis.

Blood Transfusion↗

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Liquid preservation of granulocytes.

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Blood Bactericidal Activity↗

PubMedDate not supplied

Donor platelet response and product quality assurance in plateletpheresis.

Retrospective analysis of 352 donors who underwent plateletpheresis at least four times, each using the Haemonetics Model 30 Blood Processor, indicated that a postpheresis platelet count of less than 100,000/microliter occurred in only 2.7 per cent of phereses. Restricting pheresis to those with a prepheresis platelet count of greater than 150,000/microliter would have lowered this to 1.3 per cent and eliminated only 3.7 per cent of donations. The donors' platelet counts returned to baseline approximately four days and rebounded above baseline eight to eleven days after pheresis. To minimize the chance of a donor having a postpheresis platelet count less than 100,000/microliter, the prepheresis platelet count should be greater than 150,000/microliter. A platelet count greater than 150,000/microliter immediately following the previous pheresis can be used instead of the prepheresis platelet count. The yield was related to the prepheresis platelet count, number of cycles, sex, type of procedure (platelet or platelet-leukapheresis), and the yield recorded during an individual's previous procedures. Seventy-five per cent of plateletpheresis products contained more than 3.3 x 10(11) platelets. This might be a satisfactory standard for quality assurance.

Blood Donors↗

PubMedDate not supplied

A comparison of methods for detecting leukocyte antibodies in autoimmune neutropenia.

A six-month-old girl and an 18-month-old boy with autoimmune neutropenia due to anti-NA1 are described. The antibodies were detected by granulocyte microagglutination, and their disappearance in the girl coincided with a return of a normal neutrophil count. The autoantibodies in both patients also reacted in the granulocyte cytotoxicity (GC) assay, and in one patient, in the staphylococcal protein A (SPA) assay. However, neither the GC nor the SPA assays showed the anti-NA1 specificity found by agglutination, and the presence of GC and SPA antibodies did not coincide with neutropenia. These three leukocyte antibody techniques may detect different antibodies and have different clinical significances. This report provides additional evidence of the existence of autoimmune neutropenia and indicates that the clinical role of neutrophil antibodies detected by different serologic techniques is not yet established. Antibodies detected by granulocyte agglutination were clinically significant in these two patients with autoimmune neutropenia, while the results of testing with GC and SPA were not.

Absorption↗

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Granulocyte transfusion therapy in chronic granulomatous disease. Report of a patient and review of the literature.

A l6-year-old boy with chronic granulomatous disease (CGD) and multiple Staphylococcus aureus hepatic abscesses failed to respond to intense antimicrobial therapy and surgical drainage procedures. He was started on a l3-day course of daily granulocyte transfusions obtained by intermittent-flow leukapheresis (haemonetics Model 30 [Braintree, Massachusetts]) utilizing hydroxyethyl starch. Each transfusion contained an average of 9 X l0(9) granulocytes. He defervesced on the seventh transfusion day, and the sedimentation rate returned to normal on the thirteenth transfusion day. Radionuclide scan showed decrease in size of the liver abscesses. No other new therapeutic modalities were attempted during the period of granulocyte transfusion. Although the use of granulocyte transfusion has been suggested to treat infections in CGD, we report the first successful use of granulocyte transfusion therapy in S. aureus abscess disease in CGD. Granulocyte transfusions may be helpful in treating infections refractory to standard medical-surgical management in patients with CGD and other disorders of neutrophil function.

Adolescent↗

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Effects of storage of granulocytes on their fate in vivo.

During storage of granulocytes, the chemotactic response deteriorates first and to the greatest extent. Because in vitro assays such as chemataxis may not adequately predict the fate of granulocytes in vivo, we determined the intravascular kinetics and migration into skin windows of indium-111 labeled granulocytes. Granulocytes stored for 24 hours at either 1 to 6 or 20 to 24 degrees C had significantly reduced intravascular recoveries and migration into skin windows. Granulocytes stored for only eight hours at 20 to 24 degrees C had normal intravascular recovery and migration into skin windows. In granulocytes stored for eight hours at 1 to 6 degrees C, the intravascular recovery and migration into skin windows were reduced. Because of the method of calculating migration, this observation suggests that granulocytes which do circulate after storage at 1 to 6 degrees C had decreased ability to migrate into the skin windows. Granulocytes can be stored for up to eight hours at 20 to 24 degrees C without reduction in their ability to circulate and migrate to a site of inflammation. However, since many practical issues in granulocyte storage are not resolved, granulocytes should be transfused as soon as possible after collection.

Adult↗

PubMedDate not supplied

Hemotherapy in patients undergoing blood group incompatible bone marrow transplantation.

The management of hemotherapy in 31 cases of ABO- or Rh-incompatible bone marrow transplantation is described. Our experience confirms that ABO or Rh incompatibility does not adversely affect engraftment, patient survival, or incidence of graft-versus-host disease. Eighteen recipients with ABO antibodies against the donors' red cells (major incompatibility) were managed by different combinations of plasma exchange, transfusion of incompatible donor type red cells, and removal of donor-type red cells from the bone marrow before transplant. The only serious complication was delayed hemolysis in seven of nine patients who received incompatible red cell transfusions before transplant. Thirteen patients received bone marrow containing ABO antibodies against their red cells (minor incompatibility). Five were managed by centrifuging the bone marrow to remove plasma and reduce the amount of antibody. This did not cause substantial loss of stem cell activity (60-100% of original marrow), and no patients had complications related to the marrow transfusion. In contrast, two of seven patients who received uncentrifuged bone experienced hemolysis. Two of four Rh positive recipients who received marrow from an Rh negative donor developed anti-D, possibly due to Rh positive blood components transfused after transplantation. None of eight Rh negative patients who received an Rh positive transplant has developed anti-D. Blood components should be selected to avoid transfusion of incompatible red cells and to avoid transfusion of a large amount of incompatible plasma. This may necessitate use of plasma components of a different ABO type than the red cell components.

ABO Blood-Group System↗