Effects of intensive granulocyte donation on donors and yields

Abstract

Thirteen HLA-identical bone marrow donors served as the sole source of daily granulocyte transfusions for respective marrow recipients during the period of severe neutropenia between transplantation and engraftment. They experienced 12 to 29 (median, 17) daily, continuous flow centrifugation leukapheresis procedures using hydroxyethyl starch, but no corticosteroids, with little serious difficulty. No immediate clinical reactions occurred in 90 percent of 228 procedures. Mild citrate reactions were noted in 9 percent, and only two procedures (0.8%) were discontinued due to severe reactions. Ten donors (77%) answered a questionnaire mailed weeks later, and six reported transient, late clinical adverse effects. Five had moderate dermatologic problems; one had minimal hypertension requiring no therapy. Donors were monitored daily for laboratory abnormalities while donating granulocytes. Hemoglobin concentration and platelet counts remained stable (autologous red cell transfusions had been given). Blood leukocyte counts gradually fell (p less than 0.05), particularly after 10 or more daily granulocyte donations, and this fall was associated with a decrease of about 33 percent in leukocyte yields. No attempts were made to improve yields by giving higher doses of hydroxyethyl starch or by corticosteroid stimulation. With primary emphasis on donor safety, it seems feasible for a few compatible donors to provide prolonged granulocyte transfusion support for designated patients. However, diminishing leukocyte yields may result from intensive, repeated leukapheresis.

Cataracts in neutrophil donors stimulated with adrenal corticosteroids

“…In neither situation have PSCs been reported, although, to our knowledge, donors have not undergone systematic ophthalmologic examinations. HES is given in modest doses during leukapheresis, whereas the larger doses are infused for plasma volume expansion, and it causes several mild effects in PMN donors—primarily as a result of transient plasma volume expansion—including headache and edema 23,24 . Rarely, hypersensitivity reactions and pruritis occur.…”

Preparation of granulocyte concentrates by apheresis: collection modalities in the USA

“…The rare exception, when a relative donor might be selected, is when the patient is receiving ‘matched’ platelet transfusions because of refractoriness, and the relative granulocyte/neutrophil donor is one of the matched platelet donors. Many years ago at our hospital, bone marrow transplant recipients received post-transplant prophylactic granulocytes/neutrophils from their marrow donors – most of whom were relatives[1]. …”

All formulations of hydroxyethyl starch are not the same

“…The only problems possibly related to repeated HES administration were dry skin, itching, and rash in five donors. Skin problems disappeared within weeks, except in one donor who reported “warts” in the area of previous itching 8 . Third, in a laboratory study of human blood neutrophils, blood mononuclear cells and alveolar macrophages, little to no ingestion of 14 C‐ hetastarch was demonstrated 9 .…”

“…Autopsy data from six patients did not reveal vacuolization of tissues or marrow, as evidence of HES storage, although fixation of tissues may have hampered this examination. Second, we studied 13 marrow donors, who also provided prophylactic granulocyte transfusions to their recipients, and found few adverse effects 8 . The 13 donors experienced 12 to 29 daily leukapheresis procedures using hetastarch.…”