Very rarely used, especially for adults because of the availability of G-CSF and GM-CSF.
Indications: absolute neutropenia (temporary) or granulocyte dysfunction with life-threatening infection (bacterial or fungal).
High RBC contamination so must be crossmatched. RBCs of donor must be compatible with plasma of recipient (same as RBC transfusion). DO NOT ISSUE WITH A LEUKODEPLETION FILTER!!! May be irradiated, if appropriate to prevent graft-vs-host disease. High risk of CMV transmission in susceptible recipients if donor is CMV positive. Must transfuse immediately (shelf life <24 hours). Infectious disease testing will always have to be waived --- be sure the clinicians know this, discuss it with the patient and their family, and document consent in the chart. Method of collection will depend on the age of the recipient.
1. Infants. Use for newborn with presumed sepsis and absolute neutropenia(count <500/µl). This is an emergency --- do not delay!!! Need buffy coat from one unit of fresh whole blood. Donor should be recently tested for infectious diseases (e.g. previous blood donor or mother of infant) and be CMV negative if at all possible. Easiest course is to order a buffy coat unit of granulocytes of the proper blood type from Bloodcare. Do not delay. Once the buffy coat is ready, issue for transfusion at once. One dose is usually all that is necessary.
2. Adults or older pediatric patients. Need granulocytes collected by apheresis (see apheresis--donors). Generally need serial daily doses. First collection may be needed emergently, so first donor will be collected without "prescreening" for infectious diseases. Need donor that is ABO compatible, has previous infectious disease testing (if possible), and CMV negative (if appropriate). Usually need at least 3 to 5 donors, one per day. If recipient has chronic granulomatous disease and a fungal infection, may need daily granulocytes for two to three months. Will need many different donors because of risks of harvest (see section on apheresis). This must be ordered from BloodCare.
Infectious disease testing cannot be performed on the component after it is collected and before it is transfused. Always have the clinician get permission from the patient or their family to use untested blood and have this documented in the patient's medical record as an emergency. This procedure should not be done if it's not life-saving. BloodCare also has a release form to waive testing which must be signed by the clinician before the unit can be released by the blood bank. Infectious disease testing will be performed after the transfusion in the next test run.
Amphotericin. Because of reports of lethal pulmonary reactions in patients receiving concurrent granulocyte transfusions and amphotericin, we try not to administer both of these treatments simultaneously. Have the nurse finish the amphotericin infusion and then hang the granulocytes or vice versa if at all possible.
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