The potential benefit of granulocyte transfusion therapy.
The future of granulocyte transfusions depends in large part upon our ability to overcome technical problems, particularly related to dose. Certainly the attempts at technical improvements have made an impact on granulocyte availability and donor pools large enough to support twice daily transfusions should also improve the efficacy of a series of transfusions. The majority of bacterial infections in neutropenic patients do not necessitate granulocyte transfusions due to the rapid empiric use of modern broad-spectrum antibiotics. However, a proportion still do, and selection of appropriate candidates for granulocyte transfusions may improve the outcome. The use in fungal infections remains experimental, but as has been said by others in addition to myself, should be studied. Issues of histocompatibility remain complex. Patients rendered severely immunocompromised may have less of an alloimmunization response to transfusion products, but alloimmunization continues to be a complication of granulocyte transfusions. Patients undergoing bone marrow transplant have the advantage of access to an HLA-matched marrow and granulocyte donor. The techniques of granulocyte transfusion therapy must continue to be improved and utilized in part because our microbial foes continue to change and to resist our antibiotic improvements. As George Bernard Shaw said: "There is at bottom only one genuinely scientific treatment for all diseases and that is to stimulate the phagocytes. Drugs are a delusion".
Dutcher
J P
JP
Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York.
D000818:Animals; D001424:Bacterial Infections / Q000517:prevention & control; D001803:Blood Transfusion; D006098:Granulocytes / Q000637:transplantation*; D006801:Humans; D007239:Infections / Q000628:therapy*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000628:therapy; D009181:Mycoses / Q000628:therapy; D009503:Neutropenia / Q000150:complications