Prophylaxis and Treatment of Infection of the Immunocompromised Host by Granulocyte Transfusions

Human neutrophil and macrophage chemokinesis induced by cardiopulmonary bypass: loss of DAME and IL-1 chemotaxis

Cardiopulmonary bypass (CPB) induces both cellular immunosuppression and an inflammatory response. In an effort to better characterize CPB-induced immune dysfunction, we examined the chemotaxic ability of human granulocytes and macrophages to D-Ala2-Met-enkephalin (DAME) and interleukin (IL)-1 alpha with computer-assisted microscopic image analysis before, during and after CPB. Spontaneous granulocyte and macrophage activation increased from 6% and 8% (before) to 52% and 44% (during) and then 39% and 31% after (38 h) CPB, respectively. These activated cells, characterized by conformational changes and locomotion, exhibited chemokinesis. Furthermore, no direct response to either DAME or IL-1 alpha was observed in the bypass and postoperative specimens. Cellular velocity was 0.14 and 0.07 microns s-1 for control spontaneously activated granulocytes and macrophages, respectively, and equal to the velocity observed for DAME and IL-1 alpha exposed cells, during and after CPB. CPB-unexposed cells, influenced only by the chemotaxic agents, exhibited a 3-4-fold increase in their velocity. Additionally, the migratory path of the activated cells obtained during and after CPB exhibited chemokinesis, rather than chemotaxis, when placed in a concentration gradient of either signal molecule. Cells exposed to fentanyl, the anesthetic agent, exhibited the same behavior as controls, as did those treated with morphine sulphate. However, at higher concentrations (> or = 10 ng ml-1) fentanyl and morphine reduced granulocyte and macrophage activity, demonstrating that CPB caused the opposite effect of fentanyl and also that CPB exposure overcame the pharmacological inhibitory effect of the mu opiate ligands.(ABSTRACT TRUNCATED AT 250 WORDS)

The Role of Hemapheresis Technology in Allogeneic Bone Marrow Transplantation

In this paper the impact of hemapheresis technology on 238 allogeneic bone marrow transplants performed in Pescara from 1982 through 1993 is described. Granulocyte transfusions were limited to patients with neutrophil level <0.2x109/L. An average of 4 units of packed red blood cells were required to maintain adequate hemoglobin levels. Patients with major ABO incompatibility showed an increased requirement of red blood cell support as compared to patients ABO-matched and ABO minor mismatched. For platelet support single-donor platelets collected on a blood-cell separator were given. A total of 1548 platelet transfusions were examined. The median number of platelet transfusions for each patient was 5. Platelet refractoriness occurred in 44% of patients. The hemorrhage related mortality was 0.9%.

The advancement made in the field of hemapheresis technology, as well as the improved transplant technique, have contributed to increase the post-transplant survival from 17% in the early experience (1976-1982) to 88% in the recent years (1992-1993).

Necrotizing fasciitis in two children with acute lymphoblastic leukemia

Necrotizing fasciitis is a severe, soft tissue infection, and is an unusual condition in children. The cornerstone of therapy is prompt, aggressive surgical treatment. Despite vigorous treatment, mortality rates are high. We report the occurrence of necrotizing fasciitis in two children during the granulocytopenic phase of induction chemotherapy for acute lymphoblastic leukemia. The diagnosis and treatment of necrotizing fasciitis in these two children was made more difficult by their underlying disease and its chemotherapy. The successful treatment of their infections relied on a multimodality approach. Aggressive surgical debridement was the mainstay of therapy. Adjuvant therapy was vital to the successful outcomes and included meticulous wound care, intravenous hyperalimentation, appropriate antibiotics, and granulocyte transfusions.

Defining a therapeutic dose of peripheral blood stem cells

Peripheral blood stem cells (PBSC) are now used extensively to provide rapid and durable hematopoietic reconstitution following supralethal myeloablative therapies. A major clinical issue is the quantitation of the cells responsible for reconstitution. We review here published reports of transplants using the measurement of mononuclear cells and granulocyte-macrophage colony-forming units (CFU-GM) to quantitate PBSC. In addition, we present data from three institutions where hematopoietic recovery is correlated with doses of CFU-GM or CD34+ cells. These data suggest doses of 20 x 10(4) CFU-GM or 2 x 10(6) CD34+ cells/kg body weight that provide rapid engraftment of neutrophils and platelets.

Transfusion and bone marrow transplantation

Bone marrow transplantation has prolonged the lives of a significant percentage of patients with a variety of both malignant and nonmalignant disorders. However, the impact of this treatment on a transfusion service is substantial. Large numbers of often specialized blood products are required to support these patients, and the logistics of accomplishing this taxes the ingenuity and resources of even large regional blood programs.

Current issues in transfusion therapy. 2. Indications for use of blood components

Many factors have stimulated a recent renewal of interest in indications for and use of blood components, including red blood cells, platelets, fresh-frozen plasma, cryoprecipitate, and granulocyte concentrates. Laboratory test results often provide helpful guidelines for the decision to use blood components. In this era of cost consciousness, the most important consideration still is to treat the patient in the most expedient and beneficial way. A conservative approach with an emphasis on high-quality medical practice is to choose and use blood components with consideration of both clinical information and laboratory findings.