A pilot study on impact of use of medium molecular weight hydroxyethyl starch in granulocyte apheresis using Spectra Optia



      Granulocyte transfusion (GT) is a therapeutic option for prolonged neutropenic patients with severe bacterial or fungal infections. Efficient apheresis based granulocyte collection may be better achieved by infusion of high-molecular-weight (HMW) hydroxyethyl starch (HES). But multiple adverse incidents have been reported with HMW-HES. Due to availability issues and adverse incidents related to it, use of HMW-HES has become limited. Few studies have mentioned about medium molecular weight HES (MMW-HES) (130 kDa) as efficient for this purpose with minimal adverse incidents. So, the aim was to assess the impact of the use of MMW-HES in granulocyte apheresis when using Spectra Optia.


      In this observational study, donors who received MMW-HES during granulocyte harvest were included in HES group and another group who did not receive HES were grouped as non-HES. Injection G-CSF 10 microgram/kg and tablet dexamethasone 8 mg given 12 h before for non-HES group and 6 – 8 h in case of HES group blood donors. Number of adverse incidents observed were noted. Donor/procedure parameters were compared using Mann–Whitney U test / unpaired t test.


      Granulocyte yield was significantly higher in the HES group (2.5 × 1010 vs. 1.75 × 1010, p < 0.01) and was attributed to the difference in collection efficiency (22.61% vs. 10.15%, p < 0.01). There were no significant differences in occurrence of adverse events between HES and non-HES groups.


      Our results clearly indicate that sufficient number of granulocytes can be harvested by using MMW-HES in Spectra Optia apheresis system even after short interval between mobilization to harvest.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Transfusion and Apheresis Science
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Miyao K.
        • Sawa M.
        • Kurata M.
        • Suzuki R.
        • Sakemura R.
        • Sakai T.
        • et al.
        A multicenter phase 2 study of empirical low-dose liposomal amphotericin B in patients with refractory febrile neutropenia.
        Int J Hematol. 2017; 105: 79-86
        • Illerhaus G.
        • Wirth K.
        • Dwenger A.
        • Waller C.F.
        • Garbe A.
        • Brass V.
        • et al.
        Treatment and prophylaxis of severe infections in neutropenic patients by granulocyte transfusions.
        Ann Hematol. 2002; 81: 273-281
        • Kerr J.P.
        • Liakopolou E.
        • Brown J.
        • Cornish J.M.
        • Fleming D.
        • Massey E.
        • et al.
        The use of stimulated granulocyte transfusions to prevent recurrence of past severe infections after allogeneic stem cell transplantation.
        Br J Haematol. 2003; 123: 114-118
        • Kadri S.S.
        • Remy K.E.
        • Strich J.R.
        • Gea-Banacloche J.
        • Leitman S.F.
        Role of granulocyte transfusions in invasive fusariosis: systematic review and single-center experience.
        Transfusion. 2015; 55: 2076-2085
        • Safdar A.
        • Hanna H.A.
        • Boktour M.
        • Kontoyiannis D.P.
        • Hachem R.
        • Lichtiger B.
        • et al.
        Raad II. Impact of high‐dose granulocyte transfusions in patients with cancer with candidemia: Retrospective case–control analysis of 491 episodes of Candida species bloodstream infections. Cancer: Interdisciplinary.
        Int J Am Cancer Soc. 2004; 101: 2859-2865
        • Thomas H.Price
        • Boeckh Michael
        • Harrison Ryan W.
        • McCullough Jeffrey
        • Ness Paul M.
        • Strauss Ronald G.
        • et al.
        Efficacy of transfusion with granulocytes from G-CSF/dexamethasone–treated donors in neutropenic patients with infection.
        Blood. 2015; 126: 2153-2161
        • Peters C.
        Granulocyte transfusions in neutropenic patients: beneficial effects proven?.
        Vox Sanguinis. 2009; 96: 275-283
        • Caspar C.B.
        • Seger R.A.
        • Burger J.
        • Gmür J.
        Effective stimulation of donors for granulocyte transfusions with recombinant methionyl granulocyte colony-stimulating factor.
        Blood. 1993; 81: 2866-2871
        • Bensinger W.I.
        • Price T.H.
        • Dale D.C.
        • et al.
        The effects of daily recombinant human granulocyte colony-stimulating factor administration on normal granulocyte donors undergoing leukapheresis.
        Blood. 1993; 81: 1883-1888
        • Janes A.W.
        • Mishler J.M.
        • Lowes B.
        Serial infusion effects of hydroxyethyl starch on esr, blood typing and crossmatching and serum amylase levels 1.
        Vox sanguinis. 1977; 32: 131-134
        • Bux J.
        • Cassens U.
        • Dielschneider T.
        • Duchscherer M.
        • Edel E.
        • Eichler H.
        • et al.
        Tolerance of granulocyte donors towards granulocyte colony-stimulating factor stimulation and of patients towards granulocyte transfusions: results of a multicentre study.
        Vox Sanguinis. 2003; 85: 322-325
        • Ikemoto J.
        • Yoshihara S.
        • Fujioka T.
        • Ohtsuka Y.
        • Fujita N.
        • Kokubunji A.
        • et al.
        Impact of the mobilization regimen and the harvesting technique on the granulocyte yield in healthy donors for granulocyte transfusion therapy.
        Transfusion. 2012; 52: 2646-2652
        • Brunkhorst F.M.
        • Engel C.
        • Bloos F.
        • Meier-Hellmann A.
        • Ragal- ler M.
        • Weiler N.
        • et al.
        Intensive insulin therapy and pentastarch resuscitation in severe sepsis.
        N Engl J Med. 2008; 358: 125-139
        • Perner A.
        • Haase N.
        • Guttormsen A.B.
        • Tenhunen J.
        • Klemenzson G.
        • Åneman A.
        • et al.
        Hydroxyethyl starch 130/0.42 versus Ringer’s acetate in severe sepsis.
        N Engl J Med. 2012; 367: 124-134
        • Myburgh J.A.
        • Finfer S.
        • Bellomo R.
        • Billot L.
        • Cass A.
        • Gattas D.
        • et al.
        Hydroxyethyl starch or saline for fluid resuscitation in inten- sive care.
        N Engl J Med. 2012; 367: 1901-1911
        • Henzan T.
        • Yamauchi T.
        • Yamanaka I.
        • Sakoda T.
        • Semba Y.
        • Hayashi M.
        • et al.
        Granulocyte collection by polymorphonuclear cell-targeting apheresis with medium-molecular-weight hydroxyethyl starch.
        Int J Hematol. 2021; 114 (Epub 2021 Aug 28. PMID: 34453685): 691-700
        • Nanya M.
        • Yurugi K.
        • Kato I.
        • Hiramatsu H.
        • Kawabata H.
        • Kondo T.
        • et al.
        Successful granulocyte apheresis using medium molecular weight hydroxyethyl starch.
        Int J Hematol. 2019; 110 (Epub 2019 Oct 10): 729-735
        • Lee J.H.
        • Leitman S.F.
        • Klein H.G.
        A controlled comparison of the efficacy of hetastarch and pentastarch in granulocyte collections by centrifugal leukapheresis.
        Blood. 1995; 86: 4662-4666
        • Auwerda J.J.
        • Wilson J.H.
        • Sonneveld P.
        Foamy macrophage syndrome due to hydroxyethyl starch replacement: a severe side effect in plasmapheresis.
        Ann Intern Med. 2002; 137 (https:// 1013-1014
        • Auwerda J.J.
        • Leebeek F.W.
        • Wilson J.H.
        • van Diggelen O.P.
        • Lam K.H.
        • Sonneveld P.
        Acquired lysosomal storage caused by frequent plasmapheresis procedures with hydroxyethyl starch.
        Transfusion. 2006; 46: 1705-1711 00962.x
        • Doblinger N.
        • Bredthauer A.
        • Mohrez M.
        • Hähnel V.
        • Graf B.
        • Gru-ber M.
        • et al.
        Impact of hydroxyethyl starch and modified fluid gelatin on granulocyte phenotype and function.
        Transfusion. 2019; 59: 2121-2130
        • Dullinger K.
        • Pamler I.
        • Brosig A.
        • Mohrez M.
        • Hähnel V.
        • Offner R.
        • et al.
        Granulocytapheresis with modified fluid gelatin versus high-molecular-weight hydroxyethyl starch: a matched-pair analy- sis.
        Transfusion. 2017; 57: 397-403 13898
        • Thorausch K.
        • Schulz M.
        • Bialleck H.
        • Luxembourg B.
        • Seifried E.
        • Bonig H.
        Granulocyte collections: comparison of two apheresis systems.
        Transfusion. 2013; 53 ( 1111/trf.12197): 3262-3268
        • Nanya M.
        • Yurugi K.
        • Kato I.
        • Hiramatsu H.
        • Kawabata H.
        • Kondo T.
        • et al.
        Successful granulocyte apheresis using medium molecular weight hydroxyethyl starch.
        Int J Hematol. 2019; 110: 729-735
        • Gatzemeier U.
        • Ciuleanu T.
        • Dediu M.
        • Ganea-Motan E.
        • Lubenau H.
        • Del Giglio A.
        XM02, the first biosimilar G-CSF, is safe and effective in reducing the duration of severe neutropenia and incidence of febrile neutropenia in patients with small cell or non-small cell lung cancer receiving platinum-based chemotherapy.
        J Thorac Oncol. 2009; 4: 736-740