Interdonor incompatibility as a cause of reaction during granulocyte transfusion

The first case of interdonor incompatibility associated with granulocyte transfusion is presented. The patient received Kell positive granulocyte transfusions containing about 30 ml of red cells 36 and 132 h prior to receiving a granulocyte transfusion containing anti-Kell 1/128. The chills, fever, vomiting and hypotension resulting from the red cell incompatibility, cleared with appropriate fluid therapy. Antibody detection methods must be applied to each unit of granulocytes. The patients blood should be tested with reagent grade antibody to detect small numbers of antigen-containing cells if an antibody-containing granulocyte transfusion is to be given. Routine major and minor cross-matching is insufficient. Removal of the antibody containing plasma and resuspension of the granulocytes in plasma free of irregular antibodies may be the most effective way to prevent such incompatibility.