Abstract
Granulocyte transfusion is used to manage refractory infections in patients with severe neutropenia. One of the main challenges in providing granulocyte products is the availability of a suitable donor. This study was designed to analyse deferral patterns to appropriately create a pool of granulocyte donors. A retrospective analysis was done to study the deferral pattern among donors who presented to our pediatric tertiary care hospital during the last year (August 2022-August 2023) for granulocyte apheresis. The donor selection criteria are like any apheresis donor in addition to having appropriate veins in both the arms and donor providing consent for mobilization (Dexamethasone). A total of 181 donors with a mean age of 31.3 ± 6.7 years (males 93.9%) were screened for granulocytapheresis. 61 donors (33.7%; 51 Male 10 Female) were deferred. Common reasons for deferral were poor venous access (34.4%), low platelets (24.5%), the difference in blood group between donor and recipient (19.6%), low hemoglobin (1.6%) and transfusion-transmitted infection (all HBV) reactivity (6.5%). Our study highlights a higher rate of donors deferred for granulocyte donations when compared to whole blood donations. Analysing the deferral pattern can help us identify appropriate donor groups to motivate and recruit for granulocyte donations.
Keywords: Granulocyte donation, Granulocyte transfusion, Donor deferral
Granulocyte transfusion continues to be part of the clinical management strategies to manage refractory infections in patients with severe neutropenia. Since the granulocyte apheresis products are a mix of many types of cells, there is new interest in studying the immunomodulatory effect (mainly anti-cancer effect) of these cells on the recipient [1]. One of the main challenges in providing granulocyte products, in a timely and appropriate doses manner, is the availability of a suitable donor. Since these donors are difficult to recruit and motivate, readily access to these products is often difficult [2]. The donor selection criteria for a prospective granulocyte donor are like any apheresis donor with an additional requirement of having appropriate veins in both the hands and donor providing consent for mobilization (Dexamethasone 8 mg 12 h and/or GCSF) [3]. In most situations, these granulocyte donors are close friends or relatives of the patients and provide a directed donation. There is a paucity of data on the deferral pattern (both globally and from India) of these donors who come forward for granulocyte donations. The growing risk of multi-drug resistant infections to these neutropenic patients is causing an increase in demand for granulocytes hence it is important to study and analyse deferral patterns to appropriately create a pool of granulocyte donors.
Our government-owned academic pediatric super-speciality institute initiated the in-house provision of granulocyte apheresis service and has provided more than 120 products. This is retrospective data on the pattern of donor deferrals who presented to our institute (August 2022-August 2023) for granulocyte apheresis. The mobilization protocol used was oral dexamethasone (8 mg) once 12 h before collection. A total of 181 donors, mean age 31.3 ± 6.7 years and mostly males (93.9%), presented to our transfusion medicine department and blood centre for granulocyte donations. A total of 61 donors (33.7%; 51 males and 10 females) were deferred for various reasons (Table 1) Out of 11 female donors who reported for donation, 10 were deferred and only one female donor was able to donate out of 120 granulocyte donations. All the donors were dedicated replacement donors who reported to the blood center for a specific need for a pediatric patient.
Table 1.
Pattern of granulocyte apheresis donor deferral
| Reason for deferral | Number (n = 61) | Percentage (%) |
|---|---|---|
| Poor venous access | 21 | 34.4 |
| Low platelet count | 15 | 24.5 |
| Different blood group | 12 | 19.6 |
| TTI reactive | 4 | 6.5 |
| Denied consumption of Dexamethasone | 3 | 4.9 |
| Self-deferral | 3 | 4.9 |
| Low hemoglobin | 1 | 1.6 |
| On medication (antibiotics) | 1 | 1.6 |
One of the most common causes of deferral was poor venous access (34.4%). Low platelets count (24.5%), the difference in blood group (between donor and recipient), low hemoglobin and transfusion-transmitted infection (all HBV) positivity were the causes identified during the medical screening. Around 10% of donors also refused to donate during pre-donation counselling and explanation sessions of the procedure as they either denied the mobilization or self-deferred for the procedure.
Granulocyte donation is a classical scenario of assessing the risk vs. benefit for both the recipient as well as the donor [4]. The donor screening process is long, and requires repeated visit to the blood centre, even admission in some cases (for GCSF administration) and administration of a mobilizing agent (oral or injectable) with a possible risk of side effects, hence these donors require extra counselling and support. The apheresis donation procedure is also lengthier than a typical plasma or platelets donation as well as requires phlebotomy in both arms. Considering these issues, screening and selecting a granulocyte donor is always a challenge.
Deferral patterns for both whole blood and platelet donations are widely studied, such as in recently published retrospective data from India a total of 20,167 (14.6%) donors were deferred out of 1,37,935 whole blood donors [5]. Platelets apheresis donor deferral was reported to be as high as 43.3% out of 7478 apheresis donors screened [6]. The major cause of deferral was low platelet counts (47%) which in our study was around 24%. Known published data indicates the variation of platelet counts in various parts of the country [7]. Our deferral rates are not as high as platelets donor deferral since these granulocyte products are given on a regular basis to the same patients and the patient attendants often understand the basic requirements to select the apheresis donor as they bring the most suitable donors to the blood centre.
Our study aims to highlight the deferral patterns which can help us identify the appropriate donor group to motivate and recruit for granulocyte donations. There is a need to provide these donors with adequate information material about the procedure and the pre-donation counselling session with each donor should aim at relieving the anxiety and doubts about the donation as well as the mobilization adopted. Informed consent should be obtained from all the donors indicating the mobilizing agent used and the procedure.
With a growing number of granulocyte donations in our country, there is also a need to study the long-term effect of mobilization strategies, exposure to HES (Hydroxyethyl-starch) and granulocyte donations on regular and repeat donors. To the best of our knowledge, this is the first of its kind of data on deferral patterns on donors who report for granulocyte donations to blood centres in our country. Our study highlights a higher rate of donors deferred for granulocyte donations for various reasons when compared to whole blood donations.
Acknowledgements
Acknowledgement to donors and patient’s attendants.
Author Contributions
RB and GR screened the donors during the study period as well as compiled the data; RB wrote the manuscript; SA and SD reviewed and approved the manuscript.
Funding
No funding was received for conducting this study.
Declarations
Competing Interests
The authors have no relevant financial or non-financial interests to disclose.
Footnotes
Publisher's Note
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References
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