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Febrile Neutropenia in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Perrine Parize, Anne Pouvaret, Paul-Louis Woerther, Frédéric Pène, Olivier Lortholary
To date, no well-designed study supports or refutes the benefit of granulocyte transfusion in neutropenic patients with severe infection. Little data on this topic are available, and existing studies are often underpowered [79]. A recent study demonstrated a good feasibility of granulocyte transfusion, with evidence of efficacy, but on the other hand, this treatment could be associated with severe complications (allo-immunization and transfusion-related acute lung injury) [80]. Therefore, granulocyte transfusions cannot be recommended in routine use in neutropenic patients in CCU and should be considered in specific situations such as severe cellulitis or uncontrolled invasive fungal infections after a collaborative discussion.
Responding to the Community’s Need for Therapeutic Hemapheresis
Published in James L. MacPherson, Duke O. Kasprisin, Therapeutic Hemapheresis, 2019
The oft-told origins of current machine-augmented therapeutic hemapheresis are now familiar to even the casual observer to the field.6,7 Early work in granulocyte transfusion therapy at the National Institutes of Health lead investigators to a more effective means of cell harvest. An IBM engineer entered the picture because of a close relative in need of the component therapy. The collaborative efforts of the cancer researchers and engineers resulted in development of the cell separator.8 The NCI-IBM Blood Cell Separator owed its roots in part to the Cohn fractionator used by the military in the 1940s to separate vast amounts of plasma and plasma components from whole blood.9 Cohn in fact owed his device to the cream separator long used in the dairy industry.
Invasive aspergillosis
Published in Mahmoud A. Ghannoum, John R. Perfect, Antifungal Therapy, 2019
Granulocyte transfusions provide supportive therapy for patients with neutropenia with a life-threatening infection by augmenting the number of circulating neutrophils until neutrophil recovery occurs. This strategy is recommended for patients with prolonged neutropenia and life-threatening infections refractory to conventional therapy when granulocyte recovery is predicted [10,130]. A randomized study of adjunctive granulocyte transfusions among neutropenic patients with severe bacterial and fungal infections was performed, but there was no overall effect of granulocyte transfusion. This study did not meet recruitment goals so the power to detect an effect was limited [131].
Fusariosis: an update on therapeutic options for management
Published in Expert Opinion on Orphan Drugs, 2021
Laila S Al Yazidi, Abdullah M. S. Al-Hatmi
Reversal or reduction of immunosuppression is crucial in the management of invasive fusariosis. Persistent neutropenia carries a five-fold increase in rates of mortality. The chronic use of corticosteroids is associated with a two-fold increase in mortality [14]. All immunosuppressive medications should be tapered as much as possible in patients with invasive fusariosis [9,65]. Granulocyte colony-stimulating factor (G-CSF) may be considered in patients with prolonged profound neutropenia. The roles of using G-CSF, GM-CSG, G-CSF-stimulated granulocyte transfusions and gamma interferon as adjunctive therapy for fusariosis are not well established [9]. However, in immunocompromised hosts with prolonged neutropenia and severe invasive fusariosis, every attempt to reverse the neutropenia by using G-CSF in combination with medical treatment should be welcomed [9,65]. Limited data suggest that granulocyte transfusion has been successful [66]. Kadri et al. assessed the role of granulocyte transfusion as adjunctive therapy in cases of invasive fusariosis and found a low survival rate of 30% and 45%. In this case series, authors reported a mean post-transfusion neutrophil increase of 2.46 ± 1.24 x 109/L and concluded that a prompt initiation of granulocyte transfusion may act in synergy with systemic antifungal therapy and may help to control the invasive infection until the patient’s neutrophil count has recovered [66].
Current and emerging treatments for neonatal sepsis
Published in Expert Opinion on Pharmacotherapy, 2020
Federico Carbone, Fabrizio Montecucco, Amirhossein Sahebkar
Fetal/neonatal neutrophils are defective and their storage pool early depletes during sepsis, ultimately determining poor outcomes and increased mortality. Therefore, administration of colony stimulating factors (CSFs), including granulocyte (G)-CSF and granulocyte-macrophage (GM)-CSF, has been tested as a potential therapeutic approach. As already reported by a Cochrane review in 2003, there is insufficient evidence to support the use of G-CSF or GM-CSF in neonatal sepsis practice, neither for therapeutic nor for prophylactic purposes [34], even in neutropenic infants [45]. Later, two recent randomized clinical trials (RCTs) also failed to observe a beneficial role in long-term outcomes (2 and 5 years, respectively) [46,47] (Table 1). Similarly, no evidence supports the use of granulocyte transfusion, which is also limited by severe side effects such as volume overload, infection transmission, and graft-versus-host disease [35].
Adjunctive therapy to treat neonatal sepsis
Published in Expert Review of Clinical Pharmacology, 2020
Susanna Esposito, Nicola Principi
In an attempt to evaluate whether the substitutive administration of granulocytes or buffy coats could overcome these limitations and improve the outcome of suspected or proven NS, a number of studies have been performed. A Cochrane review [35] analyzed randomized or quasi‐randomized studies that had been published until July 2011. However, the evidence was inconclusive. The total number of studies, only four, and that of patients, only 79, was too small to draw firm conclusions. Moreover, the prescribed dose and duration of treatment were different. Finally, in the three studies in which granulocyte transfusion was compared to placebo or no transfusion, no significant difference in all-cause mortality was evidenced (RR 0.89, 95% CI 0.43–1.86). In the fourth study, in which granulocyte treatment was compared to IVIG, a reduction in all‐cause mortality of borderline statistical significance (RR 0.06, 95% CI 0.00 − 1.04) was reported. Conclusions were that the evidence was inadequate to support or refute the routine use of granulocyte transfusions in neutropenic neonates with sepsis. However, research in the field was encouraged. Despite this recommendation, clinical trials in this regard have not been planned in recent years.