Granulocyte transfusions (leukocyte concentrates) are indicated in supportive therapy of neutropenic patients (absolute granulocyte count below 500/mm3) with documented infection unresponsive to appropriate antibiotics.
II. Clinical Significance:
Granulocyte transfusions are generally reserved for individuals with life threatening systemic bacterial infections (usually gram negative) unresponsive to appropriate antibiotics who have severe neutropenia (< 0.5 x 103/mm3) and in whom there is a reasonable chance that the bone marrow function will return to normal.
Refer to "General Processes, Blood Bank" protocol.
Refer to “ABO Group and Rh Type, Patient; MTS Monoclonal Grouping Cards”, “Antibody Detection & Identification; MTS Gel Card”, “Crossmatch, Immediate-Spin” and/or "Crossmatch; MTS Gel Card" procedures.
VI. Standardization: N/A
Note: A pathologist must be consulted when orders are received for a granulocyte transfusion.
1. Placing the order for granulocytes.
A. Determine the ABO group and Rh(D) type of the recipient. Refer to the “ABO Group and Rh Type, Patient; MTS Monoclonal Grouping Cards” procedure.
B. Call the blood supplier.
a. Specify the patient blood group and type.
b. Granulocytes are available as single-donor leukocyte concentrate and HLA typed leukocytes. Specify which is needed for the recipient.
c. Specify the number of consecutive days the granulocytes will be needed per orders of the physician and pathologist. Ordinarily granulocytes are given for 5 consecutive days or until there is evidence that the infection is under control or the granulocyte count prior to transfusion on 2 consecutive days is at least 1,000/mm.
Note: Post transfusion cell counting is unreliable for evaluating granulocyte transfusions, since the cells leave the vascular compartment rapidly. Effectiveness must be based on clinical improvement (e.g.: resolution of fever, favorable changes in chest x-rays, etc.).
d. Stat orders will be processed immediately. Single donor leukocytes are generally available within 24 hrs. HLA typed concentrates may take from 1-3 days depending upon donor selection and availability.
2. Receipt of the granulocyte concentrate.
A. Receive the granulocytes product in SafeTrace inventory. Refer to “Delivery, Receiving; Inventory Module: SafeTrace”.
B. Store the granulocyte concentrate at 20-24°C for up to 24 hrs without agitation.
C. Perform an antibody screen on the recipient. Refer to the “Antibody Detection & Identification; MTS Gel Card” procedure.
D. Crossmatch the granulocytes with the recipient serum. Refer to “Crossmatch, Immediate-Spin” procedure if the antibody screen is negative. Refer to "Crossmatch; MTS Gel Card" procedure if the antibody screen is positive.
E. Record results and prepare the product ID Tag and Product ID Label. . Refer to “Patient Test Results Entry; RBC Selection; Searching for Antigen-Specific Units; Reference Lab”.
F. When the granulocytes are signed out, instruct the nurse or her designee that the product must be mixed thoroughly prior to administration using a gentle rocking (back and forth) motion.
3. Administration: Granulocytes are administered as soon as possible after collection but must be infused within 24 hrs after collection. Infuse slowly, usually over a 4-hour span, using an ordinary blood administration set. DO NOT USE A MICRO-AGGREGATE FILTER.
4. Observe for adverse reactions.
A. Almost all patients show a temperature elevation of 1-2°F., 15-25% of patients may have a more severe reaction with an increase of 3-4°F. in temperature, chills and respiratory distress. In these cases, slower infusion rate and administration of antipyretics (avoid aspirin if the platelet count is low) and antihistamines are indicated. Corticosteroids may be indicated in some cases. Continue transfusion unless the reaction is severe (e.g.: dyspnea and cyanosis). Inform nursing personnel of these reactions when the unit is signed out.
B. ALWAYS CONSULT A PATHOLOGIST WHEN SYMPTOMS OF AN ADVERSE REACTION ARE OBSERVED.
C. Granulocyte concentrate contains a large number of red blood cells, therefore, the possibility of a transfusion reaction exists.
VIII. Limitations: N.A.
IX. Results Derivation: N.A.
X. Expected Result(s) and/or Critical Values: N.A.
XI. Quality Control: N.A.
1. American National Red Cross, “Hospital Manual”, pp 8-30, D-5, July, 1985.
2. “AABB Technical Manual”, pp 351-354, 10th edition, 1990.
i. August 1983 R. Schaefer
ii. July 1991 K. Wiederholt
iii. October 2003 S. Hosch (Revised: III., IV., V., VII.1.B.,2.A.,D-E., format)
iv. April 2008 N. Combs (VII.2.E.)
September 2009 S. Hosch (no changes)
November 2010 N. Combs (Revised: VII.4.A-B.)
September 2011 S. Hosch (no changes)