ALLOIMMUNIZATION AFTER GRANULOCYTE TRANSFUSIONS

Background: Although granulocyte transfusions are recommended for neut ropenic patients with bacterial infections that are unresponsive to an tibiotic therapy, the presence of white cell (WBC) antibodies in the r ecipient can render these transfusions ineffective. Study Design and M ethods: A 25-year-old man with chronic granulomatous disease experienc ed a pulmonary transfusion reaction while receiving granulocyte transf usions, and he was found to be immunized to neutrophil antigen NA2. A retrospective study of alloimmunization to HLA and neutrophil antigens in 18 patients with chronic granulomatous disease who had also receiv ed repeated granulocyte transfusions was then performed. Sera were tes ted in lymphocytotoxicity, granulocyte agglutination, granulocyte immu nofluorescence, monoclonal antibody immobilization of granulocyte anti gen, and immunoprecipitation assays. Results: After the granulocyte tr ansfusions, sera from 14 of the 18 patients contained WBC antibodies. Seven sera samples reacted in the lymphocytotoxicity, granulocyte immu nofluorescence, and granulocyte agglutination assays; seven reacted in the lymphocytotoxicity and granulocyte immunofluorescence assays but not the granulocyte agglutination assay, and four did not react. When the monoclonal antibody immobilization of granulocyte antigen assay wa s used, three sera samples reacted with Fc gamma receptor III, three w ith the 58- to 64-kDa protein carrying the neutrophil antigen NBI, one with CD11a, and one with CD18, Antibodies from three patients immunop recipitated a neutrophil protein of 60 kDa, Overall, antibodies to neu trophil antigens other than HLA could be detected in sera from eight p atients, Transfusion reactions occurred in 11 of the 14 individuals wi th WBC antibodies and in none of the 4 without antibodies, Seven pulmo nary reactions occurred in patients with WBC antibodies, The patients with WBC antibodies were given significantly more granulocyte concentr ates (78 +/- 65 vs. 29 +/- 15 units, p<0.05). Conclusion: Recipients o f granulocyte transfusions often become alloimmunized. Screening for W BC antibodies periodically during transfusions, after adverse reaction s, or before subsequent transfusions is indicated, if WBC antibodies a re present, no further granulocyte transfusions should be given unless the granulocytes are collected from HLA- and/or neutrophil antigen-co mpatible donors.