Therapeutic neutrophil transfusions: are controlled studies no longer appropriate?

The aim of this review is to determine whether sufficient data have been reported to completely define the role and/or efficacy of neutrophil transfusions in the treatment of specific types of infections in neutropenic patients. Data were collected from the literature pertaining to the use of therapeutic neutrophil transfusions. When only the controlled studies are analyzed, a significant therapeutic advantage for neutrophil transfusions plus antibiotics can be demonstrated when this treatment is compared to treatment with antibiotics alone. However, the controlled studies are vulnerable to critical analysis, and several points argue against applying data from these studies indiscriminately to all infected, neutropenic patients encountered in practice. Moreover, it is apparent when all of the data (controlled and uncontrolled studies) are tabulated, that information is insufficient to establish the efficacy of neutrophil transfusions as treatment for most types of specific bacterial infections. Several problems exist in the wholesale acceptance of liberal transfusion policies, and the benefits that justify continued controlled studies deserve emphasis.