Buffy Coat Concentrate

• This is a concentrate of the white cells and platelets obtained from a freshly centrifuged unit of whole blood.  The buffy coat separates out as a layer which can then be removed and if necessary buffy coats from different donors can be pooled for the treatment of a single patient.  The blood unit must be fresh and the buffy coat separated under sterile conditions.  Buffy coats must be used within 12 hours of preparation to get maximal effect of the leucocytes.
• Buffy coat preparations are sometimes used in the treatment of overwhelming gram negative septicaemia in young neonates.  Multiple doses of buffy coats are required to produce a clinical effect.  Because of the relatively small dose of leucocytes obtained by this method the procedure is not suitable for treatment of adults who require granulocytes.  Buffy coat preparations are not often used as leucopheresis is the preferred option.
• Caution: Hyperviscosity Syndrome may be induced by transfusing babies to a haemoglobin of greater than 160g/L.  Partial exchange transfusion may be needed.  Red cell compatibility is needed for granulocyte transfusion.
• Neonates are given granulocytes from an O Rh(D) negative, usually CMV negative donor.  If granulocytes from an O Rh(D) negative donor are not available, they may be made from a donor of a different group compatible with the baby.
• ‘Buffy coat’ one unit blood collected in the morning is spun hard and the buffy coat and upper layer of red cells harvested into a variable volume of 20-50ml.
• This will have perhaps 80% of the total white blood cells in that 450ml of donor blood and is also a packed red cell preparation.  Should ideally be irradiated prior to use.
• N.B.:   This is prepared only on special request.

Ordering

• Prior to ordering buffy coat concentrate it must be discussed with Medical Officer of NZBS.
• Granulocytes last only 12 hours once made up.
• Kept at room temperature.  Should not be refrigerated.

Indications

1. Septic neutropenic baby with neutrophils 0.5 or less.
2. Septic baby with poorly functioning neutrophils, e.g. chronic Granulomatous Disease.

Checking, Administration, Monitoring and Documentation

• As for blood and blood products.
• Checking
• Administration
• Monitoring
• Documentation

Adverse Reactions

• See Transfusion Reactions.

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