Functioning white blood cells, in particular granulocytes are important for fighting life-threatening bacterial and fungal infections. For many years, some hospital physicians have been ordering granulocytes for patients who lack white cells as a result of disease and/or treatment which has reduced their number or function.
The demand for granulocytes for transfusion has shown a steady increase since the 1990s mainly as a result of the introduction of a drug called granulocyte colony stimulating factor (G-CSF) which, if given to donors, leads to increased granulocyte numbers in the donor's blood and the collection of a larger dose of granulocytes than was previously possible. Other than in newborn children, no systematic reviews have been performed for over 10 years relating to the efficacy of granulocyte transfusions in preventing the development of infections. This review of patients of all ages other than the newborn was therefore performed to address this
Ten trials met the criteria for analysis. Combining the results of all ten studies showed that there was no significant difference between those receiving granulocytes and those who did not in terms of the numbers who died. When the two trials, which used low doses of granulocytes (less than 1 x 1010) were excluded, patients in the remaining 8 trials (who received more than 1 x 1010 granulocytes per transfusion) were less likely to die of infection than those who did not receive granulocytes transfusions. Overall however, when death from any cause was considered, patients receiving granulocyte transfusion were no less likely to die.
There were difficulties obtaining granulocytes from donor veins. Donors developed shivers and chills. Recipients suffered transfusion reactions including fevers, shortness of breath and fluid in the lungs. One patient was reported to have died as a result of side effects from the transfused white cells.
The review has several limitations. One trial administered high dose antibiotics to the patients who did not receive granulocyte transfusions but did not give these antibiotics to the patients receiving transfusions. Another study relied on “biological” randomization of patients based upon the availability, or not, of donors. All bar one study were performed more than twenty years ago, and two trials used small doses by modern standards.