RESUMO
BACKGROUND: It remains controversial whether granulocyte transfusions as a supportive treatment improve survival in patients with febrile neutropenia or granulocyte dysfunctions. We describe survival rates subsequent to granulocyte transfusions in pediatric and adults patients treated at a major blood center in Brazil. MATERIAL AND METHODS: We retrospectively reviewed the clinical charts of pediatric and adult patients treated with granulocyte transfusions at our institution from January 2000 to October 2019. We assessed demographic characteristics, clinical features, indications for transfusion, units transfused, dose of granulocytes administered and survival rates 30 and 100 days after the initial transfusion. RESULTS: We identified 64 pediatric and 67 adult patients treated with 262 granulocyte transfusions. An optimal dose (> 0.6 × 109 granulocytes per kilogram per transfused unit) was available for transfusion in 80.4 % of pediatric patients but in only 19.6 % of adults (p = 0.017). Thirty days after their first granulocyte transfusion, 38 (59.4 %) pediatric and 61 (91 %) adult patients had died. Patients receiving the optimal dose of granulocytes had better survival outcomes, but even among this sub-group, adults were more likely to die than were children either at 30 days (OR = 8.67, 95 %CI 2.69-34.9) or 100 days (OR = 6.27, 95 %CI 1.86-25.9) after their initial granulocyte transfusion. CONCLUSION: Survival rates following granulocyte transfusion varied by the dose transfused and were higher in children than in adults.
Assuntos
Neutropenia , Adulto , Brasil , Criança , Granulócitos , Humanos , Transfusão de Leucócitos/efeitos adversos , Neutropenia/etiologia , Estudos RetrospectivosAssuntos
Doadores de Sangue , Antígenos HLA/imunologia , Isoanticorpos , Transfusão de Leucócitos/efeitos adversos , Síndrome do Desconforto Respiratório/prevenção & controle , Brasil , Transfusão de Eritrócitos/métodos , Europa (Continente) , Política de Saúde , Humanos , Isoanticorpos/efeitos adversos , Isoanticorpos/sangue , Japão , Leucócitos/efeitos dos fármacos , Nova Zelândia , Síndrome do Desconforto Respiratório/imunologia , Estados UnidosRESUMO
Desde 1996 a la fecha hemos transfundido con granulocitos a 20 pacientes con 21 episodios de neutropenia febril con criterios de extrema gravedad. 14 episodios correspondieron a sepsis con germen conocido y 7 neutropenia febril sin germen aislado. Los pacientes recibieron un promedio de 3.7 aféresis, con 2.17(potencia 10) granulocitos por cada una. Los donantes fueron seleccionados entre familiares directos con estudios rutinarios para la donaci¢n de sangre, los que fueron condicionados con factor estimulante de colonias granulocíticas previa al procedimiento aferético. 15 pacientes sobrevivieron al episodio neutropénico con resolución de cuadro infeccioso. Las reacciones adversas transfucionales en los receptores fueron leves y no hubo complicaciones clínicas en los donantes. Las transfusiones de granulocitos parecen ser efectivas en pacientes con neutropenia febril sin respuesta a antibióticos