title: The relationship between alloimmunization and posttransfusion granulocyte survival: experience in a chronic granulomatous disease cohort.
abstract: BACKGROUND
  The efficacy of granulocyte transfusions in patients with HLA alloimmunization is uncertain. A flow cytometric assay using dihydrorhodamine 123 (DHR), a marker for cellular NADPH oxidase activity, was used to monitor the differential survival of transfused oxidase-positive granulocytes in alloimmunized patients with chronic granulomatous disease (CGD).
  
  
  METHODS
  Ten patients with CGD and serious infections were treated with daily granulocyte transfusions derived from steroid and granulocyte-colony-stimulating factor-stimulated donors. The proportion of neutrophils with intact oxidase activity was quantitated by DHR fluorescence on samples drawn before and 1 hour after transfusion. The incidence of acute transfusion reactions was correlated with the results of DHR fluorescence and biweekly HLA serologic screening assays.
  
  
  RESULTS
  Eight of 10 patients experienced acute adverse reactions in association with granulocyte transfusions. Four had only chills and/or fever, and four experienced respiratory compromise; all eight exhibited HLA alloimmunization. Mean (± SD) oxidase-positive cell recovery was 19.7 ± 17.4% (n = 15 transfusions) versus 0.95 ± 1.59% (n = 16) in the absence and presence of HLA allosensitization, respectively (p < 0.01). Greater than 1% in vivo recovery of DHR-enhancing donor granulocytes was strongly correlated with lack of HLA alloimmunization.
  
  
  CONCLUSIONS
  The ability to detect DHR-positive donor granulocytes by flow cytometry is strongly correlated with absence of HLA alloimmunization and lack of acute reactions to granulocyte transfusions in patients with CGD. If HLA antibodies are present and the survival of donor granulocytes is low by DHR analysis, transfusions should be discontinued, avoiding a therapy associated with high risk and unclear benefit.
authors.affiliation: Department of Transfusion Medicine and Laboratory Medicine, Warren Grant Magnuson Clinical Center and the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892-1184, USA.
authors.forename: K F
authors.initials: KF
authors.lastname: Heim
authors.forename: T A
authors.initials: TA
authors.lastname: Fleisher
authors.forename: D F
authors.initials: DF
authors.lastname: Stroncek
authors.forename: S M
authors.initials: SM
authors.lastname: Holland
authors.forename: J I
authors.initials: JI
authors.lastname: Gallin
authors.forename: H L
authors.initials: HL
authors.lastname: Malech
authors.forename: S F
authors.initials: SF
authors.lastname: Leitman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005434:Flow Cytometry; D006098:Granulocytes / Q000637:transplantation*; D006105:Granulomatous Disease, Chronic / Q000628:therapy*; D006801:Humans; D017708:Leukocyte Transfusion / Q000379:methods*; D008297:Male; D009504:Neutrophils / Q000166:cytology; D055815:Young Adult