Transfusion Medicine, 2010, 20, 160–168 doi: 10.1111/j.1365-3148.2009.00988.x ORIGINAL ARTICLE The value and practicality of granulocyte transfusion: a single oncology centre experience H. Al-Tanbal, H. Al Humaidan, R. Al-Nounou, G. Roberts, K. Tesfamichael & T. Owaidah Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 1121, Kingdom of Saudi Arabia Received 19 July 2008; accepted for publication 29 November 2009 summary. There is an increased risk of infection in patients with neutropaenia, especially in those with neutrophil counts of less than 0·5 × 10 9 /L, and neutropaenia-associated infection remains a limiting fac- tor in treating malignancy especially of haematopoi- etic origin. Transfusing donor neutrophils is a logical approach to these problems, but granulocyte transfusion (GTx), a practice first advocated in the 1960s, is under- used and although now enjoying resurgence, remains controversial. The aim of this study was to determine the practical aspects of GTx and clinical responses in patients receiving them. This is an observational ret- rospective review of GTx in patients undergoing ther- apy for predominantly haematological malignancies. We reviewed blood bank records and identified patients who received therapeutic granulocytes procured by leuka- pheresis and linked these recipients with their granu- locyte donors. We determined the reasons for GTx and their clinical and relevant haematological responses to the transfusions. We identified 22 patients receiving at least three continuous days of GTx and who had ade- quate clinical and haematological data. Most donors were relatives and ABO matched with their respective recipients. Mean age of the patients was 28·8 years. Severe aplastic anaemia was the most common diagno- sis, occurring in 9 patients (40·9%), followed by acute myeloid leukaemia in 6 (27·3%). Disseminated fun- gal infection was the most common reason for GTx, occurring in 16 patients (73%), followed by febrile neu- tropaenia in 7 patients. Fifteen (68·2%) patients showed clinical improvement. This uncontrolled retrospective observational study provides some evidence that pro- curement and use of GTx is safe for both donors and recipients and is probably an effective supportive therapy for patients with febrile neutropaenia Key words: granulocytes, leukapheresis, neutropaenia, transfusion. Neutropaenia is a common and serious limiting factor in the treatment of patients with haematological malignan- cies and bone marrow failure syndromes. Despite the use of broad spectrum anti-bacterial and anti-fungal agents, neutropaenia can be a contributing factor in the death of up to 40% of patients with haematological malig- nancies (Survey et al., 1995). Furthermore, increasingly, fungal and viral infections are a major problem in patients with haematological malignancy and bone mar- row failure syndromes (Hann et al., 1997; Hassan et al., 2003). Correspondence: Tarek M. Owaidah, Section Head, Diagnostic Hematology, Consultant Hematologist, Department of Pathology and Laboratory Medicine (MBC 10), King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Kingdom of Saudi Arabia. Tel.: (966)-1-4424328; fax: (966)-1-4424280; e-mail: towaidah@kfshrc.edu.sa In this context, granulocyte transfusion (GTx), first introduced four decades ago, is a logical supportive mea- sure in controlling such infections. The process is com- plicated, requiring recruitment, selection and scheduling of suitable volunteer donors as well as conditioning them with growth factors and/or corticosteroids in order to increase peripheral white blood cell/granulocyte count and yield. Furthermore, decision to initiate the process is critical, as delay could compromise the desired clinical outcome Nevertheless, the precise role for donor GTx remains controversial, partly because of the lack of proper clinical trials. The potential usefulness of GTx in the management of neutropaenic patients was first mooted in mid-1960s (Freireich et al., 1965; Levin et al., 1965), and support for it increased in the mid-1970s (Higby and Henderson, 1975; McLennan et al., 1977). However, interest declined in the following decades because of  2010 The Authors 160 Journal compilation  2010 British Blood Transfusion Society