🩸 Chapter 521 · Neutrophil (Granulocyte) Transfusions

Nelson Textbook of Pediatrics 22nd Edition | Granulocyte transfusions: indicated for severe neutropenia (ANC <500/μL) with bacterial or fungal infection unresponsive to appropriate antibiotics and growth factors, or qualitative neutrophil defects (e.g., chronic granulomatous disease) with progressive infection. Donors stimulated with G-CSF + dexamethasone. Dose: 1-2 × 10⁹ neutrophils/kg. Limited evidence; not routinely recommended. Risks: febrile reactions, alloimmunization, CMV transmission, pulmonary reactions.

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📋 30 Clinical Scenarios -- Granulocyte Transfusions

📇 High‑Yield Review Cards (Granulocyte Transfusions)

🩺 Clinical Scenarios: Granulocyte Transfusion Decisions

Select a presentation for transfusion guidance.

📋 Stepwise Management of Granulocyte Transfusions

🔑 Key Principles -- Nelson Chapter 521
• Indications (limited): Severe neutropenia (ANC <500/μL) with bacterial/fungal infection unresponsive to appropriate antibiotics and G-CSF/GM-CSF. Qualitative neutrophil defects (e.g., chronic granulomatous disease) with progressive life-threatening infection.
• Donor stimulation: G-CSF (5-10 mcg/kg) + dexamethasone (8 mg) 12-24 hours before apheresis.
• Dose: 1-2 × 10⁹ neutrophils/kg per transfusion (minimum 1 × 10¹⁰ per adult).
• Frequency: Daily until infection resolves or neutrophil recovery.
• Risks: Febrile reactions, alloimmunization (HLA antibodies), CMV transmission, pulmonary reactions (TRALI), graft-versus-host disease (irradiate products).
• Evidence: No definitive randomized controlled trial evidence of benefit; used as salvage therapy.

    ⚡ Reflex Prompts -- Clinical Decisions in Granulocyte Transfusion

    📖 Summary: Neutrophil (Granulocyte) Transfusions -- Nelson Ch 521