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
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
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.
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)