ASSESSING THE OUTCOMES OF PATIENTS FOLLOWING GRANULOCYTE TRANSFUSION
(Abstract release date: 05/19/16)
EHA Library. Soutar R. 06/09/16; 133130; E1581
Dr. Richard Soutar
Contributions
Contributions
Abstract
Abstract: E1581
Type: Eposter Presentation
Background
The use of granulocytes in transfusion medicine is not a new concept. Despite continual advances in the process and over half a century of recorded use in clinical practice, the efficacy of these blood products continues to be the subject of much debate. Authors worldwide have reported differing results regarding the outcomes of patients following such transfusions and our understanding of the clinical course of patients receiving transfusions today is largely at the same level as the original pioneers in this field.
Aims
The aim of this project was to assess the use of granulocyte transfusions in the West of Scotland in recent years and evaluate the outcomes of the patients who received these transfusions.
Methods
A retrospective single-arm case series study was carried out with the data being collected for the time period between January 2012 and October 2015.
Results
In total, 20 patients (10 [50%] women and 10 [50%] men) were included. Granulocyte transfusions were discontinued in 8 patients (40%), as there was clinical improvement. This included the patients requiring granulocytes for: severe neutropenia with a non-healing dental extraction (deceased due to end stage AML); severe neutropenia with an infected haematoma (deceased with cause unknown); neutropenic sepsis (alive); pancytopenia (alive); pneumonia (alive); peri-anal abscess (alive); necrotising fasciitis (alive); and lung fungal infection (alive).Eight patients (40%) also deteriorated and for this reason the granulocyte transfusions were stopped. This included the patients that required granulocytes for the following reasons: two patients with neutropenic pyrexia (both deceased with the cause of death being respiratory failure for one patient and a chest infection refractory to treatment for the other patient); severe neutropenia with pericarditis and a fungal infection (deceased due to neutropenic sepsis); neutropenic sepsis (deceased due to neutropenic sepsis); neutropenic sepsis with lung abscess (deceased from chest infection that was refractory to treatment); pancytopenia (deceased due to haemodynamic instability); nasal sinus fungal infection (deceased from neutropenic sepsis); and Klebsiellaoxytoca sepsis (deceased due to respiratory failure).Interestingly, from the patients that deteriorated the following pathogens were noted in microbiological testing: Amoeba (querying Acanthamoeba), throat and sputum Candida, heavy yeast growth, Klebsiellaoxytoca, and Pseudomonas aeruginosa along with Staphylococcus hominis in the blood. When comparing the above two groups (i.e. 8 patients showing clinical improvement versus 8 patients deteriorating), the median age was 40 years (IQR = 47.5; minimum age = 2; maximum age = 64; 6 women [75%]; 2 men [25%]) for the patients that improved and 60 years (IQR = 39.25; minimum age = 0.92; maximum age = 66; 2 women [25%]; 6 men [75%]) for the patients that deteriorated.
Conclusion
The data confirms the variable outcomes in patients receiving granulocyte transfusions. However those patients who showed clinical improvement were noted to be younger than those who deteriorated while there was also a discrepancy between the sexes with women typically having better outcomes than men. Atypical organisms were also associated with poorer outcomes suggesting a multifactorial cause for a less successful outcome. Although this is a non-randomised study the patient outcomes are encouraging considering their clinical severity. We therefore continue to use granulocyte transfusions derived from Buffy coats in these situations.
Session topic: E-poster
Keyword(s): Granulocyte transfusion, Outcome, Patient
Type: Eposter Presentation
Background
The use of granulocytes in transfusion medicine is not a new concept. Despite continual advances in the process and over half a century of recorded use in clinical practice, the efficacy of these blood products continues to be the subject of much debate. Authors worldwide have reported differing results regarding the outcomes of patients following such transfusions and our understanding of the clinical course of patients receiving transfusions today is largely at the same level as the original pioneers in this field.
Aims
The aim of this project was to assess the use of granulocyte transfusions in the West of Scotland in recent years and evaluate the outcomes of the patients who received these transfusions.
Methods
A retrospective single-arm case series study was carried out with the data being collected for the time period between January 2012 and October 2015.
Results
In total, 20 patients (10 [50%] women and 10 [50%] men) were included. Granulocyte transfusions were discontinued in 8 patients (40%), as there was clinical improvement. This included the patients requiring granulocytes for: severe neutropenia with a non-healing dental extraction (deceased due to end stage AML); severe neutropenia with an infected haematoma (deceased with cause unknown); neutropenic sepsis (alive); pancytopenia (alive); pneumonia (alive); peri-anal abscess (alive); necrotising fasciitis (alive); and lung fungal infection (alive).Eight patients (40%) also deteriorated and for this reason the granulocyte transfusions were stopped. This included the patients that required granulocytes for the following reasons: two patients with neutropenic pyrexia (both deceased with the cause of death being respiratory failure for one patient and a chest infection refractory to treatment for the other patient); severe neutropenia with pericarditis and a fungal infection (deceased due to neutropenic sepsis); neutropenic sepsis (deceased due to neutropenic sepsis); neutropenic sepsis with lung abscess (deceased from chest infection that was refractory to treatment); pancytopenia (deceased due to haemodynamic instability); nasal sinus fungal infection (deceased from neutropenic sepsis); and Klebsiellaoxytoca sepsis (deceased due to respiratory failure).Interestingly, from the patients that deteriorated the following pathogens were noted in microbiological testing: Amoeba (querying Acanthamoeba), throat and sputum Candida, heavy yeast growth, Klebsiellaoxytoca, and Pseudomonas aeruginosa along with Staphylococcus hominis in the blood. When comparing the above two groups (i.e. 8 patients showing clinical improvement versus 8 patients deteriorating), the median age was 40 years (IQR = 47.5; minimum age = 2; maximum age = 64; 6 women [75%]; 2 men [25%]) for the patients that improved and 60 years (IQR = 39.25; minimum age = 0.92; maximum age = 66; 2 women [25%]; 6 men [75%]) for the patients that deteriorated.
Conclusion
The data confirms the variable outcomes in patients receiving granulocyte transfusions. However those patients who showed clinical improvement were noted to be younger than those who deteriorated while there was also a discrepancy between the sexes with women typically having better outcomes than men. Atypical organisms were also associated with poorer outcomes suggesting a multifactorial cause for a less successful outcome. Although this is a non-randomised study the patient outcomes are encouraging considering their clinical severity. We therefore continue to use granulocyte transfusions derived from Buffy coats in these situations.
Session topic: E-poster
Keyword(s): Granulocyte transfusion, Outcome, Patient
Abstract: E1581
Type: Eposter Presentation
Background
The use of granulocytes in transfusion medicine is not a new concept. Despite continual advances in the process and over half a century of recorded use in clinical practice, the efficacy of these blood products continues to be the subject of much debate. Authors worldwide have reported differing results regarding the outcomes of patients following such transfusions and our understanding of the clinical course of patients receiving transfusions today is largely at the same level as the original pioneers in this field.
Aims
The aim of this project was to assess the use of granulocyte transfusions in the West of Scotland in recent years and evaluate the outcomes of the patients who received these transfusions.
Methods
A retrospective single-arm case series study was carried out with the data being collected for the time period between January 2012 and October 2015.
Results
In total, 20 patients (10 [50%] women and 10 [50%] men) were included. Granulocyte transfusions were discontinued in 8 patients (40%), as there was clinical improvement. This included the patients requiring granulocytes for: severe neutropenia with a non-healing dental extraction (deceased due to end stage AML); severe neutropenia with an infected haematoma (deceased with cause unknown); neutropenic sepsis (alive); pancytopenia (alive); pneumonia (alive); peri-anal abscess (alive); necrotising fasciitis (alive); and lung fungal infection (alive).Eight patients (40%) also deteriorated and for this reason the granulocyte transfusions were stopped. This included the patients that required granulocytes for the following reasons: two patients with neutropenic pyrexia (both deceased with the cause of death being respiratory failure for one patient and a chest infection refractory to treatment for the other patient); severe neutropenia with pericarditis and a fungal infection (deceased due to neutropenic sepsis); neutropenic sepsis (deceased due to neutropenic sepsis); neutropenic sepsis with lung abscess (deceased from chest infection that was refractory to treatment); pancytopenia (deceased due to haemodynamic instability); nasal sinus fungal infection (deceased from neutropenic sepsis); and Klebsiellaoxytoca sepsis (deceased due to respiratory failure).Interestingly, from the patients that deteriorated the following pathogens were noted in microbiological testing: Amoeba (querying Acanthamoeba), throat and sputum Candida, heavy yeast growth, Klebsiellaoxytoca, and Pseudomonas aeruginosa along with Staphylococcus hominis in the blood. When comparing the above two groups (i.e. 8 patients showing clinical improvement versus 8 patients deteriorating), the median age was 40 years (IQR = 47.5; minimum age = 2; maximum age = 64; 6 women [75%]; 2 men [25%]) for the patients that improved and 60 years (IQR = 39.25; minimum age = 0.92; maximum age = 66; 2 women [25%]; 6 men [75%]) for the patients that deteriorated.
Conclusion
The data confirms the variable outcomes in patients receiving granulocyte transfusions. However those patients who showed clinical improvement were noted to be younger than those who deteriorated while there was also a discrepancy between the sexes with women typically having better outcomes than men. Atypical organisms were also associated with poorer outcomes suggesting a multifactorial cause for a less successful outcome. Although this is a non-randomised study the patient outcomes are encouraging considering their clinical severity. We therefore continue to use granulocyte transfusions derived from Buffy coats in these situations.
Session topic: E-poster
Keyword(s): Granulocyte transfusion, Outcome, Patient
Type: Eposter Presentation
Background
The use of granulocytes in transfusion medicine is not a new concept. Despite continual advances in the process and over half a century of recorded use in clinical practice, the efficacy of these blood products continues to be the subject of much debate. Authors worldwide have reported differing results regarding the outcomes of patients following such transfusions and our understanding of the clinical course of patients receiving transfusions today is largely at the same level as the original pioneers in this field.
Aims
The aim of this project was to assess the use of granulocyte transfusions in the West of Scotland in recent years and evaluate the outcomes of the patients who received these transfusions.
Methods
A retrospective single-arm case series study was carried out with the data being collected for the time period between January 2012 and October 2015.
Results
In total, 20 patients (10 [50%] women and 10 [50%] men) were included. Granulocyte transfusions were discontinued in 8 patients (40%), as there was clinical improvement. This included the patients requiring granulocytes for: severe neutropenia with a non-healing dental extraction (deceased due to end stage AML); severe neutropenia with an infected haematoma (deceased with cause unknown); neutropenic sepsis (alive); pancytopenia (alive); pneumonia (alive); peri-anal abscess (alive); necrotising fasciitis (alive); and lung fungal infection (alive).Eight patients (40%) also deteriorated and for this reason the granulocyte transfusions were stopped. This included the patients that required granulocytes for the following reasons: two patients with neutropenic pyrexia (both deceased with the cause of death being respiratory failure for one patient and a chest infection refractory to treatment for the other patient); severe neutropenia with pericarditis and a fungal infection (deceased due to neutropenic sepsis); neutropenic sepsis (deceased due to neutropenic sepsis); neutropenic sepsis with lung abscess (deceased from chest infection that was refractory to treatment); pancytopenia (deceased due to haemodynamic instability); nasal sinus fungal infection (deceased from neutropenic sepsis); and Klebsiellaoxytoca sepsis (deceased due to respiratory failure).Interestingly, from the patients that deteriorated the following pathogens were noted in microbiological testing: Amoeba (querying Acanthamoeba), throat and sputum Candida, heavy yeast growth, Klebsiellaoxytoca, and Pseudomonas aeruginosa along with Staphylococcus hominis in the blood. When comparing the above two groups (i.e. 8 patients showing clinical improvement versus 8 patients deteriorating), the median age was 40 years (IQR = 47.5; minimum age = 2; maximum age = 64; 6 women [75%]; 2 men [25%]) for the patients that improved and 60 years (IQR = 39.25; minimum age = 0.92; maximum age = 66; 2 women [25%]; 6 men [75%]) for the patients that deteriorated.
Conclusion
The data confirms the variable outcomes in patients receiving granulocyte transfusions. However those patients who showed clinical improvement were noted to be younger than those who deteriorated while there was also a discrepancy between the sexes with women typically having better outcomes than men. Atypical organisms were also associated with poorer outcomes suggesting a multifactorial cause for a less successful outcome. Although this is a non-randomised study the patient outcomes are encouraging considering their clinical severity. We therefore continue to use granulocyte transfusions derived from Buffy coats in these situations.
Session topic: E-poster
Keyword(s): Granulocyte transfusion, Outcome, Patient
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