Granulocytes in England are unusual as they are provided as a component pooled from whole blood. Helen and Suzy discuss when their use should be considered and what to watch out for when using them
Granulocyte component
Pooled from 10 whole blood donations → buffy coats → red cell and platelet reduced → one bag with plasma and PAS.
- Vol ~200ml per bag
- 9 x109 granulocytes/bag (grans)
- 5 units of platelets per bag
- 15g hb per unit; hct 0.15
- Stored at room temperature
- Transfuse by midnight the day after donation
- Irradiated
Usual dose 2-3 bags (20 ml/kg in children)
Historically supplied Tues-Sat. Now limited availability of O pos on Mondays. If D neg woman of child bearing potential consider anti D cover (see guidelines)
Apheresis granulocytes used internationally – stimulate donors with GCSF +/- dexamethasone – not acceptable for non directed donations in the UK. Previously done at Kings and Bristol but not more recently.
NHSBT portfolio of blood components
Indications for granulocytes
NHSBT guidelines state granulocytes can be given if
- Neutrophils <0.5 x109 due to congenital or acquired bone marrow failure
- Having definitive treatment
- Severe refractory bacterial or fungal infection
- Neutrophil recovery anticipated
Can also give for congenital neutrophil dysfunction.
No allowance for e.g.
- acquired neutrophil dysfunction e.g. in MDS
- prophylaxis (1y or 2y)
