Increased Granulocyte Collection with the Blood Cell Separator and the Addition of Etiocholanolone and Hydroxyethyl Starch

Abstract

A total of 401 leukapheresen have been performed on 73 donors to collect granulocytes for transfusion to infected leukopenic recipients. The pretreatment of the donor with etiocholanolone and the addition of hydroxyethyl starch to the extracorporeal circulation significantly increaaed the total number of granulocytea collected. Adverse side effects were minimal. The majority of donors underwent the procedure on IS occasions over a period of eight weeks. Follow-up donors two or more years later h a revealed no long-term adverse side effects from leukaphercsb or from the addition of etiocholancl. lone and hydroxyethyl starch.

Granulocyte transfusions in the G-CSF era. Where do we stand?

“…The efficiency of separation of granulocytes from red blood cells during leucopheresis was improved by the addition of the red cell sedimenting agents pentastarch and hydroxyethylstarch. 9 It was noted that harvest yields could be further enhanced by elevating the donors pre-collection neutrophil count using etiocholanolone 10 and subsequently glucocorticoids. 11 Consequently, yields of up to 10 11 granulocytes could be obtained from donors with CML and 1-3 Â 10 10 granulocytes from healthy glucocorticoid stimulated donors.…”

A New Method to Collect Granulocytes Using a Low Dose of Hydroxyethyl Starch

“…In con trast, the collection efficiency was not de pendent on donor's WBC count. This figure characterizing the efficiency of leukaphere sis is usually not reported in the literature, but evaluation of the available data indicates that the 64% efficiency of the new method is higher than that obtained with other auto mated methods [5,6,9,25,26], but some what lower than that obtained by the manual gravity leukapheresis procedure [11]. The high efficiency of granulocyte collection might have depended on the formation of a clear granulocyte band during a discontin ued flow.…”

“…More granulocytes could be harvested from each liter of donor blood (0.507 x 1010) by the low HES leukapheresis procedure than by the other automated centrifugation methods employing donor premedication and HES (range from 0.12 x 1010 to 0.36 xlO10) [5,6,9,25,26], However, a higher donor WBC count prior to the procedure resulted in higher yields of granulocytes per LBP. An average of0.6 56 x 106 granulocytes could be harvested by the new method from each liter of donor blood when prednisone was given in three divided doses [16].…”

“…They can be collected by apheresis techniques exploiting the princi ple of reversible adherence of granulocytes to nylon filters (filtration leukapheresis) [1][2][3] or by using centrifugation techniques [2,[4][5][6]. The latter approach requires that donors be premedicated with corticosteroids [5][6][7] or etiocholanolone [8][9] to recruit maximum numbers of polymorphonuclear leukocytes into the blood stream. The gran ulocytes can then be separated from red crease donors' plasma volume [12], limiting the number of procedures that one donor can undergo in a short period of time.…”

Phase II Study of Prophylactic Non-Irradiated Granulocyte Transfusions in AML Patients Receiving Induction Chemotherapy

“…And with only ~5% of total body neutrophils circulating in the peripheral circulation at a given time, the number of recovered WBCs was minimal (~1 × 10 10 ), the majority were lymphocytes, and a median increment in ANC of only ~100/µl was observed per GT. Technology has since improved, including strategies to combat RBC contamination such as the addition of the nonimmunogenic hydroxyethyl starch (HES) to cause RBC rouleaux phenomenon and improve the efficiency of granulocyte separation, as well as the development of the continuous-flow blood cell separator [12]. In addition, routine GCSF and/or corticosteroid administration stimulate the margination of neutrophils leading to a routine obtainment of an effective granulocyte dose [13,14].…”