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Bailliere's Best Practice & Research.... Dec 2000In transfusion medicine, mononuclear leukocytes have been studied more often as contaminants of red blood cells or platelets responsible for adverse transfusion outcomes... (Review)
Review
In transfusion medicine, mononuclear leukocytes have been studied more often as contaminants of red blood cells or platelets responsible for adverse transfusion outcomes than as therapeutic cells; leukocyte transfusion has been effective in augmenting recipient immunity only in limited clinical situations. Studies in leukocyte reduction and leukocyte transfusion have progressed separately as if the leukocytes' adverse and therapeutic effects result from different immunological mechanisms. With growing clinical experience, however, it is increasingly clear that some adverse immune effects may be exploited for therapeutic benefit. Advances in clinical immunology, understanding of the variety of cells and functions in the leukocyte fraction of blood, and blood component preparation technology may lead to new ways of deriving immunological benefit from transfused blood leukocytes while minimizing their adverse effects. This chapter reviews the current uses of leukocyte reduction and mononuclear leukocyte transfusion, with an emphasis on the relationship between transfusion-associated graft-versus-host disease and donor lymphocyte infusion in controlling relapsed leukaemias.
Topics: Antigen-Presenting Cells; Blood Component Removal; Cytomegalovirus Infections; Epstein-Barr Virus Infections; Graft vs Host Disease; Graft vs Leukemia Effect; Humans; Immunity; Immunosuppression Therapy; Leukocyte Transfusion; Leukocytes; Vaccines
PubMed: 11102278
DOI: 10.1053/beha.2000.0101 -
Bone Marrow Transplantation Jun 2020Severe neutropenia remains among the most common complications associated with hematological diseases and their treatment, especially in the early poststem cell... (Review)
Review
Severe neutropenia remains among the most common complications associated with hematological diseases and their treatment, especially in the early poststem cell transplantation. Managing life-threatening infections associated with prolonged and profound neutropenia thus remains an essential component for the optimal care of patients undergoing transplant. Several therapeutic interventions have been attempted either to limit the duration of neutropenia through granulocyte colony stimulating factors (GCSF), or to treat associated infections through the use of granulocyte transfusions. The efficacy and safety of granulocyte transfusions have been controversial, and the conflicting results reported by several trials can be explained by the significant variability related to patient selection, timing of initiation, and duration of transfusions, preparation methods among multiple others. We herein report a case of life-threatening necrotizing fasciitis post haploidentical stem cell transplant, responding to the combination of antibiotics and daily transfusions of non-irradiated GCSF stimulated leukocytes from healthy donors without surgical intervention. We also provide a concise review of the available literature regarding the use of this intervention, its efficacy and safety and comparison of irradiated with non-irradiated transfusions.
Topics: Fasciitis, Necrotizing; Granulocyte Colony-Stimulating Factor; Granulocytes; Hematopoietic Stem Cell Transplantation; Humans; Leukocyte Transfusion; Stem Cell Transplantation
PubMed: 31700136
DOI: 10.1038/s41409-019-0743-6 -
Hematology/oncology Clinics of North... Oct 2019Pediatric oncology patients will likely require numerous transfusions of blood products, including red blood cell, platelet, and plasma transfusions, during the course... (Review)
Review
Pediatric oncology patients will likely require numerous transfusions of blood products, including red blood cell, platelet, and plasma transfusions, during the course of their treatment. Although strong evidence-based guidelines for these products in this patient population do not exist, given the morbidities associated with the receipt of blood products, practitioners should attempt to use restrictive transfusion strategies.
Topics: Blood Transfusion; Child; Erythrocyte Transfusion; Hematologic Diseases; Humans; Leukocyte Transfusion; Medical Oncology; Neoplasms; Platelet Transfusion
PubMed: 31466612
DOI: 10.1016/j.hoc.2019.05.011 -
Transfusion Medicine Reviews Oct 2011The treatment of anemia and thrombocytopenia with allogeneic cell transfusions is an effective and well-developed technology. However, leukocyte replacement transfusion...
The treatment of anemia and thrombocytopenia with allogeneic cell transfusions is an effective and well-developed technology. However, leukocyte replacement transfusion has been frustrated by the physiology of the leukocytes. To achieve effective leukocyte replacement, the continuous-flow centrifugal blood cell separator was developed, and it soon proved to be an important instrument for separation, collection, and transfusion of all the components of the blood. Thus, the continuous-flow centrifugal blood cell separator has become an important instrument in the science of blood collection and transfusion.
Topics: Adoptive Transfer; Cell Separation; Cell Size; Centrifugation; Equipment Design; Etiocholanolone; Granulocytes; Hematopoietic Stem Cell Mobilization; History, 20th Century; Humans; Hydroxyethyl Starch Derivatives; Immunocompromised Host; Infections; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukocyte Transfusion; Lymphocytes; Maryland; Plasma Substitutes; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Rheology; Texas
PubMed: 21632206
DOI: 10.1016/j.tmrv.2011.04.004 -
Vox Sanguinis Oct 2007Blood transfusion is a newly recognized cause of microchimerism, the stable persistence of a minor population of allogeneic cells. Relatively recent advances in... (Review)
Review
Blood transfusion is a newly recognized cause of microchimerism, the stable persistence of a minor population of allogeneic cells. Relatively recent advances in polymerase chain reaction technology have spawned new information about the frequency and aetiology of transfusion-associated microchimerism (TA-MC). Although conceptually related to fetal-maternal microchimerism, TA-MC is a distinct and separate entity. Evidence of TA-MC has been strongest among patients with severe traumatic injuries who receive relatively fresh blood products shortly after an episode of massive haemorrhage. The presence of a focal deficit in the cellular immunologic repertoire prior to transfusion that happens to match a blood donor's human leucocyte antigen type also appears to be an important predisposing factor. TA-MC seems to be common (affecting approximately 10% of transfused injured patients), enduring (lasting years to decades) and pronounced (involving up to 5% of circulating leucocytes and multiple immunophenotypic lineages suggestive of haematopoietic engraftment). Further study of this topic may reveal important information regarding potential clinical consequences of TA-MC, as well as basic haematologic and immunologic processes.
Topics: Chimerism; Humans; Leukocyte Transfusion; Polymerase Chain Reaction
PubMed: 17845255
DOI: 10.1111/j.1423-0410.2007.00954.x -
Lakartidningen Mar 2018There are no randomized controlled trials proving the clinical benefit of granulocyte transfusions. However, clinical experience and a number of case studies suggest... (Review)
Review
There are no randomized controlled trials proving the clinical benefit of granulocyte transfusions. However, clinical experience and a number of case studies suggest that granulocyte transfusions may be life-saving in certain situations. In our opinion granulocyte transfusions should be considered for patients with profound neutropenia and severe, life-threatening infection not responding to antibiotic or antifungal therapy. Since the clinical effect seems to be dose-dependent, the granulocyte concentrate should contain a large number of cells, which usually means that the donor should be mobilized with steroids and G-CSF. Regular blood donors as well as relatives to the patient can be used for granulocyte donations with apheresis technique after information of the process. Granulocyte transfusion should be given daily as long as the indication remains. The clinical efficacy of the transfusions should be evaluated daily.
Topics: Critical Illness; Donor Selection; Granulocytes; Humans; Infections; Leukocyte Transfusion; Neutropenia; Procedures and Techniques Utilization
PubMed: 29558012
DOI: No ID Found -
Tidsskrift For Den Norske Laegeforening... Feb 2009Granulocyte transfusion is used in the treatment of severe, sustained or complicated infection and neutropenia. In recent years, the method's efficacy has improved and... (Review)
Review
BACKGROUND
Granulocyte transfusion is used in the treatment of severe, sustained or complicated infection and neutropenia. In recent years, the method's efficacy has improved and its availability increased. After the introduction of granulocyte colony-stimulating factor (G-CSF) there has been a growing interest for granulocyte transfusion, and effective methods for collection and transfusion of granulocytes are now in clinical use. This paper presents clinical, immunological and ethical challenges, our own experience with granulocyte harvesting and documentation of efficacy.
MATERIAL AND METHODS
The paper is based on our own experience with granulocyte transfusion and literature retrieved though a non-systemic search.
RESULTS
The efficacy of granulocyte transfusion with respect to morbidity and mortality is still debated, and the method currently has no place in routine treatment of documented infection and neutropenia. However, the treatment could be an alternative for patients with inadequate response to conventional treatment and for whom sustained neutropenia is expected. The combined use of G-CSF, hydroxyethyl starch and corticosteroids considerably increases the yield of granulocytes collected for transfusion.
INTERPRETATION
Granulocyte transfusion is clinically feasible, but more research is needed to define clinical indications and to document the procedure's efficacy. Larger randomized controlled efficacy trials are needed.
Topics: Bacterial Infections; Filgrastim; Granulocyte Colony-Stimulating Factor; Granulocytes; Humans; Hydrocortisone; Hydroxyethyl Starch Derivatives; Leukocyte Transfusion; Neutropenia; Plasma Substitutes; Recombinant Proteins; Sepsis; Tissue and Organ Harvesting; Treatment Outcome
PubMed: 19247402
DOI: 10.4045/tidsskr.09.34313 -
Beitrage Zu Infusionstherapie Und... 1981
Review
Topics: Blood Preservation; Blood Transfusion; Cell Separation; Centrifugation; Filtration; Granulocytes; Humans; Leukapheresis; Leukocyte Transfusion; Leukocytes; Transplantation, Homologous
PubMed: 7020691
DOI: No ID Found -
Transfusion Nov 2017Allergic transfusion reactions are drawbacks to the benefits of transfusion. Classically, allergic transfusion reactions depend on histamine release from mast cells or...
BACKGROUND
Allergic transfusion reactions are drawbacks to the benefits of transfusion. Classically, allergic transfusion reactions depend on histamine release from mast cells or basophils, but other leukocyte subsets may also be important. Thus, we propose to better define the exact leukocyte subsets involved in allergic transfusion reactions.
STUDY DESIGN AND METHODS
The overall objective of the current study was to compare the activation of specific peripheral blood leukocyte subsets (monocytes, neutrophils, eosinophils, and basophils) in a cohort of 13 patients who received chronic transfusions and had a history of allergic transfusion reactions compared with a control group of patients who received chronic transfusions and had no history of allergic transfusion reactions. Leukocyte subsets were analyzed by flow cytometry at baseline and after red blood cell transfusion, and cytokine levels in platelet-free plasma collected at the same time points were measured by Luminex assay.
RESULTS
Flow cytometry and cytokine profiles before and after transfusion did not differ significantly between patients who did and did not have a history of allergic transfusion reactions (p > 0.05). However, post-transfusion samples from both groups showed a decrease in CD63 expression in basophils, monocytes, and eosinophils and a decrease in CD45 expression in all leukocyte subsets compared with pretransfusion samples. Interleukin 10 levels increased after transfusion in the group with a history of allergic transfusion reactions (p = 0.0469), and RANTES (regulated upon activation, normal T-cell expressed and secreted) was significantly decreased post-transfusion in all patients (p = 0.0122).
CONCLUSION
None of the leukocyte subsets from patients who had a history of allergic transfusion reactions significantly increased in activation either before or after transfusion. All leukocyte subsets from patients who did and did not have a history of allergic transfusion reactions decreased in their activation profile upon transfusion challenge.
Topics: Adolescent; Child; Child, Preschool; Female; Humans; Hypersensitivity; Leukocyte Common Antigens; Leukocyte Transfusion; Leukocytes; Lymphocyte Activation; Male; Plasma; Tetraspanin 30; Young Adult
PubMed: 28880378
DOI: 10.1111/trf.14275 -
Urology May 2017To evaluate the effect of leukoreduced-only perioperative blood transfusion (PBT) and corresponding survival outcomes in a radical cystectomy cohort of patients.
OBJECTIVE
To evaluate the effect of leukoreduced-only perioperative blood transfusion (PBT) and corresponding survival outcomes in a radical cystectomy cohort of patients.
MATERIALS AND METHODS
We analyzed data from 1026 patients who underwent radical cystectomy at our institution. PBT was defined as transfusion in the intraoperative or within the postoperative hospitalization period. Multivariable analyses using Cox proportional hazards were performed to measure the association between PBT, patient variables, and 3 primary end points: recurrence-free survival, disease-specific survival, and overall survival. Kaplan-Meier curves estimated survival times and were compared with log-rank test.
RESULTS
Overall, of a total of 1026 patients, 341 (33.2%) received leukoreduced PBT. The median follow-up was 27.5 months. Transfused patients were more likely to be female, had higher estimated blood loss, lower preoperative hemoglobin, were more likely to have received neoadjuvant chemotherapy, or had undergone a continent urinary diversion. Higher pathologic tumor and nodal stage were observed more frequently in patients who received PBT. On multivariable analysis, PBT was not associated with worse recurrence-free survival, disease-specific survival, and overall survival (all P > .05). Kaplan-Meier curves did not show any significant differences (all P > .05) between the transfused and nontransfused groups. In addition, no differences were found in regard to timing of transfusion, that is, intraoperative vs postoperative, in distinct analysis.
CONCLUSION
No significant association was found between leukoreduced PBT and worse survival outcomes at short-term follow-up in a contemporary cohort of cystectomy patients. Prospective long-term follow-up is warranted.
Topics: Aged; Cystectomy; Disease-Free Survival; Female; Follow-Up Studies; Humans; Intraoperative Care; Kaplan-Meier Estimate; Leukocyte Transfusion; Male; Middle Aged; Neoplasm Staging; Outcome and Process Assessment, Health Care; Postoperative Care; United States; Urinary Bladder Neoplasms
PubMed: 28011275
DOI: 10.1016/j.urology.2016.12.015