Response to granulocyte transfusions in the alloimmunized patient

The effect of alloimmunization to white blood cells upon patients receiving granulocyte transfusions was studied. Eighteen episodes of sepsis associated with neutropenia were treated with 149 granulocyte transfusions. All products were crossmatched using a recent patient serum. Each serum was tested for granulocyte-specific antibody using the granulocyte indirect immunofluorescence test (GIIFT), and for HLA antibody, using the standard NIH lymphocytotoxicity assay. In 14 episodes of sepsis treated with 114 granulocyte transfusions, the transfusions were discontinued because there was evidence of control of infection, with and without bone marrow recovery. In this group, four per cent of all transfusions were incompatible by the GIIFT and six per cent by lymphocytotoxicity. During four episodes of sepsis treated with 35 granulocyte transfusions, blood cultures remained positive and the product was discontinued because of death. In this group, 31 per cent of all transfusions were incompatible by the GIIFT and 6 per cent by lymphocytotoxicity. The unfavorable outcome in patients with granulocyte antibodies suggests that these antibodies have an adverse effect upon the function of the transfused granulocyte.