1319 BUFFY COAT TRANSFUSION: AN EFFECTIVE ALTERNATIVE IN SEVERELY ILL, GRANULOCYTE-DEPLETED NEWBORNS

Abstract

Granulocyte transfusion may be life-saving in newborns with bacterial sepsis, neutropenia and severe depletion of the bone marrow mature neutrophil storage pool (NSP). Since a buffy coat is more readily available than granulocytes obtained by leukapheresis, we studied the efficacy of fresh (<24hrs), irradiated buffy coat transfusion in this high risk group. Bone marrow aspiration was done on 16 newborns with clinical sepsis and an absolute neutrophil count (ANC) <2000/mm³. Four were found to have severe depletion of NSP, i.e. (metas + bands + segs) <7% of nucleated cells, and were given 10cc/kg of a buffy coat preparation. Three of these infants received 0.5-1x 10⁹ neutrophils/mm³/kg. Two had an increase to normal ANC within 12 hours and recovered from clinical sepsis. The rise in ANC continued and was far in excess of that predicted based on the number of granulocytes transfused. The third infant had a transient rise to 2350 neutrophils/mm³ 6 hours post-transfusion, but subsequently remains neutropenic for 6+ weeks. A fourth infant whose buffy coat provided only 0.06 × 10⁹ neutrophils/mm³/kg received a second transfusion from the same unit 12 hours later, recovered fully from neutropenia, and survived. Twelve infants with NSP >7% were not transfused; one of these had an NSP of 8.5% and expired. The remainder survived but remained neutropenic 4-16 days. Fresh buffy coat preparations appear to accelerate recovery from neutropenia and may improve survival in clinically septic NSP-depleted newborns.

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