Granulocyte transfusions and outcome of alloimmunized patients with gram-negative sepsis

The effect of white cell alloimmunization on patient outcome during gram-negative sepsis treated with granulocyte transfusions was studied. Twenty-five episodes of sepsis were observed; 19 were associated with resolution of sepsis and six with continuing sepsis and death. Compatibility testing included the granulocyte indirect immunofluorescence test and the lymphocytotoxicity assay. The number of compatible and incompatible granulocyte transfusions determined by the indirect immunofluorescence test compared with patient outcome was significant (X2 = 44, p less than 0.001). The same comparison with the lymphocytotoxicity assay was not significant (X2 = 3, p greater than 0.05). The duration of the granulocytopenia after the first positive blood culture was 10 days or longer in 13 patients, and 12 of the 13 survived. The duration of the granulocytopenia was less than 10 days in 12 patients, and five of the six deaths occurred in this group. These five patients died without evidence of bone marrow recovery and with persistent gram-negative sepsis. Each had granulocyte-specific antibody of broad specificity and none received five consecutive compatible transfusions.