The effect of white cell alloimmunization on patient outcome during gram-negative sepsis treated with granulocyte transfusions was studied. Twenty-five episodes of sepsis were observed; 19 were associated with resolution of sepsis and six with continuing sepsis and death. Compatibility testing included the granulocyte indirect immunofluorescence test and the lymphocytotoxicity assay. The number of compatible and incompatible granulocyte transfusions determined by the indirect immunofluorescence test compared with patient outcome was significant (X2 = 44, p less than 0.001). The same comparison with the lymphocytotoxicity assay was not significant (X2 = 3, p greater than 0.05). The duration of the granulocytopenia after the first positive blood culture was 10 days or longer in 13 patients, and 12 of the 13 survived. The duration of the granulocytopenia was less than 10 days in 12 patients, and five of the six deaths occurred in this group. These five patients died without evidence of bone marrow recovery and with persistent gram-negative sepsis. Each had granulocyte-specific antibody of broad specificity and none received five consecutive compatible transfusions.
The effect of alloimmunization to white blood cells upon patients receiving granulocyte transfusions was studied. Eighteen episodes of sepsis associated with neutropenia were treated with 149 granulocyte transfusions. All products were crossmatched using a recent patient serum. Each serum was tested for granulocyte-specific antibody using the granulocyte indirect immunofluorescence test (GIIFT), and for HLA antibody, using the standard NIH lymphocytotoxicity assay. In 14 episodes of sepsis treated with 114 granulocyte transfusions, the transfusions were discontinued because there was evidence of control of infection, with and without bone marrow recovery. In this group, four per cent of all transfusions were incompatible by the GIIFT and six per cent by lymphocytotoxicity. During four episodes of sepsis treated with 35 granulocyte transfusions, blood cultures remained positive and the product was discontinued because of death. In this group, 31 per cent of all transfusions were incompatible by the GIIFT and 6 per cent by lymphocytotoxicity. The unfavorable outcome in patients with granulocyte antibodies suggests that these antibodies have an adverse effect upon the function of the transfused granulocyte.
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