The Product

• "Buffy Coat" 1 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 20-50 ml.
• 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.

Indications

• Septic neutropenic baby (neutrophils <3 x 10⁹/L in first week or <1 x 10⁹/L subsequently).
• Septic baby with poorly functioning neutrophils (e.g chronic granulomatous disease).

Complications

• As for other blood cell products -infections, allergy, leucocyte antibodies, red cell antibody problems and volume overload.
• Raising red cell count too much causing hyperviscosity syndrome.
• Potential GVH (Graft versus Host) disease if not irradiated.
• Potential source of CMV infection UNLESS from Anti-CMV negative donor - Please Request.

Administration

• Granulocytes last only a few hours and survive best at room temperature.
  • The preparation should be infused as soon as received and should NOT be refrigerated.
• Draw up via a 170u blood filter.
• Transfuse over 2-3 hours maximum.
• It would be hard to give too many granulocytes to a septic neutropenic baby by infusing even a whole buffy coat preparation.
  • Volume that can be given is usually dictated by volume that baby can receive.
• NOTE the high Hb content of the product. Be very careful not to raise the baby's Hb too high or hyperviscosity problems and serious consequences may occur.

For further details, see the Big Blue Blood Bank Book