Plasma-reduction for Apheresis Granulocyte transfusions in pediatric patients

Area of Science:

• Hematology
• Pediatric Oncology
• Transfusion Medicine

Background:

• Granulocyte transfusion (GT) is used for infections in neutropenic patients.
• Pediatric GT dosing is not well-established due to volume overload risks.
• Limited data exists on optimal pediatric GT protocols.

Purpose of the Study:

• To report on the tolerability and efficacy of high-volume, apheresis-collected granulocyte transfusions in pediatric patients.
• To assess absolute neutrophil count (ANC) increments following GT in pediatric cases.
• To evaluate the feasibility of frequent GT administration in children.

Main Methods:

• Retrospective case report of two pediatric patients undergoing bone marrow transplant with active infections.
• Administration of 100 mL plasma-reduced, apheresis-collected granulocyte transfusions.
• Monitoring of absolute neutrophil count (ANC) increments post-transfusion.

Main Results:

• Dramatic ANC increments observed: median 1-hour ANC 5524/µL and 24-hour ANC 3880/µL.
• Pediatric patients tolerated doses of 4-6 × 10⁹/kg plasma-reduced GT.
• Detectable ANC levels were maintained with GT administered every 3 days.

Conclusions:

• High-volume, apheresis-collected GT is feasible and effective in pediatric patients.
• Specific dosing (4-6 × 10⁹/kg) and frequency (every 3 days) show promise for managing infections.
• Further research is warranted to establish definitive pediatric GT guidelines.