The determinants of donor safety and product quality in optimization of apheresis granulocyte harvest: An experience from a tertiary care oncology centre in India


      Allogeneic granulocyte transfusions play a substantial role in treatment of lifethreatening neutropenia-associated infections in patients undergoing intensive chemotherapy and hematopoietic stem cell transplant. Granulocyte harvest by apheresis is considered a safe and effective method to obtain adequate therapeutic granulocyte dosage for clinical effectiveness. This study described the experiences associated with apheresis granulocyte harvest procedures in our tertiary care haemato-oncology centre. We have analysed the incidence of adverse events (AEs) with associated potential risk factors contributing to donor safety and improvement in product quality. Retrospective data of 131 healthy allogeneic donors who underwent granulocyte harvest from May 2016 to July 2020 were analyzed. AEs were observed in overall 29 procedures (22.13%), including 14.50% citrate reactions, 7.6% venous access-related reactions, and 1.52% vasovagal reactions. Older age (p = 0.012) and higher body mass index (p = 0.015) in donors were significant variables found associated with a higher incidence of AEs. There was no significant impact of AEs on granulocyte product yield (p = 0.41) with a median collection yield of 1.73 × 10 10 cells/ unit. In multivariate analysis, post-mobilization parameters like total leukocyte counts (p = 0.036), absolute neutrophil counts (p = 0.042), and platelet counts (p = 0.006) showed a positive correlation with higher product yield. All the donors successfully donated and tolerated granulocyte colony stimulating factor plus dexamethasone mobilization and granulocyte apheresis harvest without any serious AEs. Our study shows that optimal technical and procedural modifications during apheresis granulocyte harvest procedures can overcome the associated potential risks by providing donor safety and improving product quality.


      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


        • Pagano M.B.
        • Morton S.
        • Cohn C.S.
        • Gross S.
        • Kutner J.
        • Lewin A.
        • et al.
        An international registry of granulocyte transfusions.
        Transfus Med Hemotherapy. 2018; 45: 318-322 2018 Aug 24
        • Brockmann F.
        • Kramer M.
        • Bornhäuser M.
        • Ehninger G.
        • Hölig K.
        Efficacy and side effects of granulocyte collection in healthy donors.
        Transfus Med Hemotherapy. 2013; 40 (Epub 2013 Jul 19): 258-264
      1. Morton S, Stanworth S . INF 276/5 Revised Clinical guidelines for the use of granulocyte transfusions.:13. Granulocyte working group, NHS; Blood and Transplant; 2021. 〈〉.

        • Lee J.-J.
        • Chung I.-J.
        • Park M.-R.
        • Kook H.
        • Hwang T.-J.
        • Ryang D.-W.
        • et al.
        Clinical efficacy of granulocyte transfusion therapy in patients with neutropenia-related infections.
        Leukemia. 2001; 15: 203-207
        • Simon T.L.
        • McCullough J.
        • Snyder E.L.
        • Solheim B.G.
        • Strauss R.G.
        Book: Rossi’s principles of transfusion medicine.
        fifth ed. John Wiley & Sons Inc, Chichester, West Sussex; Hoboken, NJ2016: 271-277 (1 p. Chapter 23. Neutrophil collection and transfusion)
      2. Estcourt LJ, Stanworth SJ, Doree C, Blanco P, Hopewell S, Trivella M, et al. Granulocyte transfusions for preventing infections in people with neutropenia or neutrophil dysfunction. Cochrane gynaecological, neuro-oncology and orphan cancer group, editor. cochrane database syst rev [Internet]; 2015 Jun 29 〈〉.

        • Price T.H.
        • Boeckh M.
        • Harrison R.W.
        • McCullough J.
        • Ness P.M.
        • Strauss R.G.
        • et al.
        Efficacy of transfusion with granulocytes from G-CSF/dexamethasone–treated donors in neutropenic patients with infection.
        Blood. 2015; 126 (Epub 2015 Sep2): 2153-2161
        • Suzanne A.
        • Arinsburg D.O.
        Transfusion Medicine and Hemostasis. Granulocyte products, Chapter 35.
        Elsevier Inc, 2013: 35 (
        • Wiles W.C.
        • Rodger E.
        • Dale D.C.
        Combined administration of G-CSF and dexamethasone for the mobilization of granulocytes in normal donors: optimization of dosing.
        Transfusion. 2000; 40: 40060642
        • David Stroncek Cynthia L.
        • Mathew Dean
        • Follman
        • Susan F.Leitman
        Kinetics of G-CSF induced granulocyte mobilization in healthy subjects.
        Transfusion. 2002; 42: 597-602 x
      3. Marleen M. Neyrinck, Hans Vrielink: on behalf of “the Joint Task Force for Education and Certification”. Calculations in Apheresis. Journal of Clinical Apheresis; 2014: Wiley Periodicals, Inc. 〈〉.

        • Worel Nina
        • Kurz Martin
        • Peters Christina
        • Hocker Paul
        Serial granulocytepheresis under daily administration of rHuG-CSF: effects on peripheral blood counts, collection efficiency, and yield.
        Transfusion. 2001; 41 x
      4. Lise J. Estcourt, Simon J. Stanworth, Sally Hopewell, Carolyn Doree, Marialena Trivella and Edwin Massey. Cochrane Database Syst Rev.;4: CD005339. 〈〉.

      5. Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. U.S. Department of Health and Human services; 2017:155. 〈〉.

        • 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: collection methods and granulocyte yield.
        Transfusion. 2012; 52: 2646-2652 x. Epub 2012 Apr 23
      6. Benjamin J., Greco, Bet H. Shaz. Adverse donor reactions, Transfusion Medicine and Hemostasis (Second Edition); 2013. 〈〉.

        • Miguel Angel Rodriguez-Calero
        • Ian Blanco-Mavillard
        • Jose Miguel Morales-Asencio
        • Ismael Fernandez-Fernandez
        • Enrique Castro-Sanchez
        • Joan Ernest de Pedro-Gomez
        Defining risk factors associated with peripheral venous cannulation: a systematic review and meta-analysis.
        Heart & Lung. 2020; 49 (Epub 2020 Feb 11): 273-286
      7. Sheppard Chelsea A, Hillyer Cristopher D. Therapeutic apheresis in Consultative hemostasis and Thrombosis (Second Edition); 2007. 〈〉.

        • Pagliariccio A.
        • Vavic N.
        • Bulajic M.
        • Marinozzi M.
        P-14; is there a causal link between anxiety and vasovagal reactions?.
        Transfus Apher Sci. 2012; 47: S28
        • Karen Quillen Yu.Ying Yau
        • Susan F.Leitman
        The determinants of granulocyte yield in 1198 granulocyte concentrates collected from unrelated volunteer donors mobilized with dexamethasone and granulocyte-colony-stimulating factor: a 13-year experience.
        Transfusion. 2009; 49 (x. Epub 2008 Nov 19): 421-426
        • Weingarten Christina
        • Pliez Sarah
        • Tschiedel Eva
        • et al.
        Granulocyte transfusions in critically ill children with prolonged neutropenia: side effects and survival rates from a single-center analysis.
        Eur J Pediatr. 2016; 175 (Epub 2016 Sep 8): 1361-1369